Pacemaker implantation within 30 days of surgical AVR yields worse outcomes
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Among nearly 25,000 Swedish patients who received surgical aortic valve replacement, permanent pacemaker implantation within the first 30 days of the procedure increased risk for all-cause mortality and HF hospitalization.
Permanent pacemaker implantation did not affect risk for endocarditis.
Natalie Glaser, MD, PhD, of Stockholm South General Hospital and Karolinska Institutet, Stockholm, and colleagues conducted the observational, population-based cohort study to assess long-term outcomes after primary surgical AVR in patients who underwent postoperative permanent pacemaker implantation.
The study featured all patients who underwent surgical AVR in Sweden from 1997 to 2018 and survived the first 30 days after surgery. Patients were excluded if they received a permanent pacemaker or implantable cardioverter defibrillator preoperatively, had concomitant surgical treatment for another valve, received emergency surgical treatment, had endocarditis preoperatively or underwent surgical treatment resulting from endocarditis.
Overall, the study included 24,983 patients (mean age, 70 years; 37% women), of whom 3.4% underwent permanent pacemaker implantation within 30 days of surgery. Mean follow-up was 7.3 years, during which time 41.3% of patients died in the nonpacemaker group and 38.3% died in the pacemaker group.
At 10 years after surgical treatment, survival was 52.8% in the pacemaker arm compared with 57.5% in the nonpacemaker arm, and at 20 years, the survival rates dropped to 18% in the pacemaker arm and 19.6% in the nonpacemaker arm.
The pacemaker group demonstrated an increased risk for all-cause mortality (HR = 1.14; 95% CI, 1.01-1.29; P = .03) and HF hospitalization (HR = 1.58; 95% CI, 1.31-1.89; P < .001), but not endocarditis (P = .42).
The researchers postulated that the results cannot be directly generalized to patients receiving transcatheter AVR, but it is likely the findings are valid in this patient population as well.
“The results of our study are clinically relevant, especially in an era when transcatheter AVR is used among younger patients with lower surgical risk,” they wrote. “Younger patients have a longer life expectancy; therefore, the association of permanent pacemaker implantation with adverse outcomes becomes more relevant in this patient population. Thus, the risks associated with permanent pacemaker implantation after transcatheter AVR are becoming increasingly important.”
They added that the findings “further suggest that future research should investigate how to avoid permanent pacemaker dependency after surgical and transcatheter aortic valve replacement.”
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