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Few patients require cardiac implantable electronic devices after cardiac surgery
In a study of nearly 40,000 patients who underwent cardiac surgery at a single institution from 1996 to 2008, the incidence of cardiac implantable electronic device implantation was 4% and varied based on the type of operation.
Researchers also found that patients who received cardiac implantable electronic devices after cardiac surgery had increased early survival but decreased late survival compared with patients who did not receive a device after surgery.
“The population of people undergoing cardiac surgery is getting older and sicker, with more comorbidities. This was an overdue study to determine the incidence rate of needing cardiac implantable electronic devices after open heart surgery in this era,” Khaldoun G. Tarakji, MD, MPH, staff physician in the section of electrophysiology and pacing in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, told Cardiology Today.
The study included 39,546 patients with no prior cardiac implantable electronic devices implanted who underwent cardiac surgery at the Cleveland Clinic between Jan. 1, 1996, and Jan. 31, 2008. Researchers compared incidence, indications, risk factors and survival among patients with and without cardiac implantable electronic devices.
In total, 1,608 patients (4.1%) underwent postoperative cardiac implantable electronic device implantation prior to hospital discharge after cardiac surgery. The most common devices implanted were permanent pacemakers (2.8%) and implantable cardioverter defibrillators (1.3%). Most patients received a device for conduction disease, but in 23% of patients a cardiac implantable electronic device was implanted for secondary prevention of ventricular arrhythmias, according to the findings.
The researchers also reported that the incidence of cardiac implantable electronic device implantation varied based on the type of surgery. Valve surgeries and redo operations were associated with more device implantations, according to the researchers. The highest cardiac implantable electronic device implantation rate was among patients who underwent tricuspid valve surgery, following by mitral valve replacement, tricuspid valve repair and aortic valve replacement. After surgical aortic valve replacement, the incidence of cardiac implantable electronic device implantation was 6.2%, which was less than the rates of permanent pacemaker implantation seen in previous transcatheter aortic valve registries (7% to 42.5% with various devices), according to the researchers. This provides “a modern benchmark to compare the rates of device implantation after percutaneous valve procedures,” they wrote.
When the researchers examined survival, the risk for death within 1 year was significantly lower among patients who received cardiac implantable electronic devices (HR = 0.38; 95% CI, 0.22-0.65), but risk for death beyond 1 year was significantly higher in the device group (HR = 1.3; 95% CI, 1.2-1.5).
Risk factors for device implantation following cardiac surgery included older age, left ventricular dysfunction, valvular disease, atrial fibrillation and cardiac surgery prior to this study, according to the findings.
“These findings are in harmony with previous studies. But, what it adds for the cardiologist or cardiac surgeon is being able to discuss with the patient data on the potential need for a cardiac implantable electronic device based on the type of surgery you’re doing,” Tarakji said. “That can take the discussion with patients to a different level of accuracy of predicting who may need a device and who may not.” – by Dave Quaile
Disclosure: The researchers report no relevant financial disclosures.