TY - JOUR
T1 - Long-term risk of heart failure and mortality following mitral valve surgery in patients with and without right ventricular pacemaker
AU - Andersson, Charlotte
AU - Schou, Morten
AU - Gislason, Gunnar H.
AU - Køber, Lars
AU - Torp-Pedersen, Christian
AU - Monahan, Kevin M.
PY - 2020
Y1 - 2020
N2 - Objectives: Patients undergoing mitral valve surgery are at risk of developing postoperative conduction blocks and have a high incidence of heart failure (HF). Mitral valve surgery often results in reduced left ventricular systolic ejection fraction following surgery and the imposition of dyssynchrony with right ventricular (RV) pacing may further compromise stroke volume. Our aim was to investigate the risks of HF and mortality in patients with vs without RV pacemaker placement (PPM) after mitral valve surgery. Methods: Using Danish nationwide databases, we identified all patients undergoing mitral valve repair or replacement surgery between 1997 and 2017, who were free from HF at baseline. The association of PPM implanted within 30 days following surgery with long-term risks of HF and mortality was investigated by multivariable Cox regression models. Results: Of 4072 patients (33% female), 248 (6%) had a PPM implanted at 30-day postsurgery. Patients with PPM were older (68 vs 63 years), had a higher prevalence of concomitant aortic valve surgery (15% vs 11%), ischemic heart disease (13% vs 8%), and atrial fibrillation (19% vs 12%), compared with patients without PPM. Over a median follow-up of 5 years, 68 (27%) vs 825 (22%) patients with vs without PPM developed HF and 74 (30%) vs 1018 (27%) died. In multivariable-adjusted models, the hazard ratios associated with PPM were 1.00 (0.78-1.30), P =.93 for HF, and.96 (0.76-1.21), P =.72 for mortality. Conclusions: Postoperative implantation of a permanent RV pacemaker does not alter the long-term risks of HF and mortality following mitral valve surgery.
AB - Objectives: Patients undergoing mitral valve surgery are at risk of developing postoperative conduction blocks and have a high incidence of heart failure (HF). Mitral valve surgery often results in reduced left ventricular systolic ejection fraction following surgery and the imposition of dyssynchrony with right ventricular (RV) pacing may further compromise stroke volume. Our aim was to investigate the risks of HF and mortality in patients with vs without RV pacemaker placement (PPM) after mitral valve surgery. Methods: Using Danish nationwide databases, we identified all patients undergoing mitral valve repair or replacement surgery between 1997 and 2017, who were free from HF at baseline. The association of PPM implanted within 30 days following surgery with long-term risks of HF and mortality was investigated by multivariable Cox regression models. Results: Of 4072 patients (33% female), 248 (6%) had a PPM implanted at 30-day postsurgery. Patients with PPM were older (68 vs 63 years), had a higher prevalence of concomitant aortic valve surgery (15% vs 11%), ischemic heart disease (13% vs 8%), and atrial fibrillation (19% vs 12%), compared with patients without PPM. Over a median follow-up of 5 years, 68 (27%) vs 825 (22%) patients with vs without PPM developed HF and 74 (30%) vs 1018 (27%) died. In multivariable-adjusted models, the hazard ratios associated with PPM were 1.00 (0.78-1.30), P =.93 for HF, and.96 (0.76-1.21), P =.72 for mortality. Conclusions: Postoperative implantation of a permanent RV pacemaker does not alter the long-term risks of HF and mortality following mitral valve surgery.
KW - cardiovascular research
KW - heart failure
KW - mitral valve surgery
KW - right ventricular pacemaker
U2 - 10.1111/jocs.14847
DO - 10.1111/jocs.14847
M3 - Journal article
C2 - 32652752
AN - SCOPUS:85087685521
VL - 35
SP - 2598
EP - 2604
JO - Journal of Cardiac Surgery
JF - Journal of Cardiac Surgery
SN - 0886-0440
IS - 10
ER -