Abstract 12108: Long-term Follow-up of Patients with Permanent Pacemaker Implantation after Cardiac Surgery
Background: Each year approximately 20,000 patients (pts) undergo permanent pacemaker (PPM) implantation postoperatively after cardiac surgery for bradycardia or atrioventricular block. However, the long-term follow-up of these pts is lacking. The objective of this investigation was to examine the long-term outcomes of pts who underwent postoperative PPM implantation after cardiac surgery.
Methods: We included 6,268 consecutive pts who underwent cardiac surgery at the Minneapolis Veterans Administration Medical Center between 1987 and 2010. Pts who had a PPM implantation within 30 days of cardiac surgery were identified from cardiology and surgery databases. Pacemaker interrogation results and dependence status were obtained from device clinic records. Predictors of PPM implantation was examined by logistic regression and long-term survival by Cox regression.
Results: Mean age was 66±10 and 75% of pts had isolated coronary artery bypass surgery (CABG). Overall, 141 (2.2%) pts underwent PPM implantation 9±6 days after surgery. PPM was required in 1% of pts after CABG, 6%–8% of pts after mitral or aortic valve replacement and 14%–17% of pts after double-valve or complex surgery. In multivariable regression, age, diuretic use, cardiopulmonary bypass time and surgery other than isolated CABG were independent predictors of PPM implantation. After 5.6±4.2 years of follow-up, 40% of the pts were PPM dependent. Another 30% of the pts were paced >80% of the time but not PPM dependent. Over 7.2±5 years of follow-up, 2270 (36%) patients died. Patients who had PPM had a higher mortality than those without PPM (45% vs. 36% p=0.02). However, after adjusting for age, sex, type of surgery and cardiopulmonary bypass time, undergoing PPM implantation was no longer associated with long-term mortality (hazard ratio 1.3; 95% confidence interval 0.9 to 1.9; p=0.17).
Conclusions: In long-term follow-up 30% of the pts who underwent PPM implantation after cardiac surgery were neither PPM dependent and nor paced a substantial amount of time. Requiring PPM implantation after cardiac surgery did not influence long-term survival.
- © 2010 by American Heart Association, Inc.