Abstract 1629: Cardiac Implantable Electronic Device (CIED) Implantation After Cardiac Surgery: Occurrence, Risk Factors and Survival Outcomes
Background and Objective: Many patients after cardiac surgery require a cardiac implantable electronic device (CIED) prior to discharge (pacemaker or ICD). We characterized the occurrence and risk factors for requiring CIED implantation after cardiac surgery and examined long-term survival in these patients.
Methods: From 1996 through 2008, 39,546 patients underwent cardiac surgery at the Cleveland Clinic (mean age 63±14 years). Risk factors for needing a device were identified by multivariable logistic regression using bootstrap bagging as the primary variable identification method. A propensity model was constructed to obtain a risk-adjusted comparison of long-term survival between the group who needed a device and the one that did not. We identified 1387 well-matched pairs.
Results: 1,608 patients (4%) needed CIED implant after cardiac surgery. Of these patients, 1107 had a pacemaker and 501 had an ICD implanted. Risk factors for postoperative CIED included older age, history of syncope, lower ejection fraction, atrial fibrillation, prior cardiac surgery, aortic valve stenosis and mitral valve regurgitation. Among propensity-matched groups there were 380 deaths over an average 2 years of follow up. While early survival was better for the device group (p=0.0005), there was no statistically significant difference in late survival between the two groups (p=0.3).
Conclusion: About 4% of patients undergoing cardiac surgery require CIED implant. The long-term survival of these patients is similar to their counterparts who don’t need a device implant after surgery.