gms | German Medical Science

Introduction: Rhythm disturbances and transient conduction disorders are frequently seen following cardiac surgery procedures. Unfortunately, a few are permanent and result in the implantation of a permanent pacemaker (PM) what additionally might be related to an extend hospital stay. Hence, in order to reduce periods of intensive care unit and hospital stay and the subsequent costs this population is on particular clinical interest. The purpose of this study was primary to identify factors predicting a postoperative PM implantation and to evaluate its impact on outcome.

Material and methods: A total of 5740 patients (pts) underwent CABG and/or valve or aortic surgery in our institution in a 3-year period between January 2007 and December 2009. The overall mean age was 68.6±9.9 years and 1779 pts (31.0%) were female. Clinical data, the postoperative course as well as outcome of all pts were recorded and studied retrospectively. The primary endpoint was the PM implantation.

Results: The overall 30-days mortality during the study period was 6.8% (n=226), whereas no pts died after PM implantation. Permanent PM was performed in 66 pts (1.2%), the mean period of implantation was 14.6±7.9 days (range 6 to 42 days, median 12 days). The length of initial ICU stay (2.2±3.3 days vs. 4.5±4.9) and the overall hospital stay (13.0±0.1 days vs. 20.6±1.2) days of pts received a permanent PM was significantly prolonged (p<0.0001). Pts with PM more frequently underwent valve and aortic procedures as well as redo operations and had more complete right bundle branch block (RBBB) prior to surgery (p<0.0001). Indications for PM implantations were a higher degree of AV block (n=48; 72.7%), bradyarrhythmia or junctional rhythms (n=12; 18.2%) or sinus bradycardia (n=6; 9.1%). Multivariate logistic regression analysis revealed the redo operation (OR 0.58, CI 0.44 to 0.79) and aortic valve surgery, either isolated or with concomitant mitral and/or tricuspid valve and/or CABG (OR 1.79, CI 1.39 to 2.29) as independent predictors for postoperative PM implantation (p<0.0001).

Conclusion: PM implantation following cardiac surgery can be performed with an excellent in hospital outcome but contributes to a prolonged ICU and hospital stay. The finding of the multivariate analysis confirms the redo operation as well as the valve surgery, especially aortic valve replacement. Interestingly, neither concomitant ablation procedure nor a small aortic anulus (<21mm) are associated with a higher incidence of PM implantation.