Incidence, risk factors, and long-term outcomes associated with permanent pacemaker implantation after aortic root replacement

Abstract

Permanent pacemaker implantation (PPI) after AVR is associated with long-term mortality. However, data regarding PPI after aortic root replacement (ARR) is lacking. Herein we describe the incidence, risk factors, and long-term outcomes of PPI after ARR. Consecutive patients undergoing ARR from 2005-2020 were selected after excluding those with endocarditis, Type A dissection, or preoperative PPI. Patients requiring PPI after ARR were identified, along with the indication and timing. Independent factors associated with PPI after ARR were identified and long-term survival was assessed. The incidence of PPI was 3.8% (n=85) among 2240 patients undergoing ARR. PPI was performed a median of 7 days (IQR 5-12) after ARR most commonly for complete heart block (73%). Bicuspid aortic valve (OR 1.89, p=0.02), female gender (OR 1.74, p=0.04), preoperative heart block (OR 2.70, p=0.02), and prior AVR (OR 2.18, p=0.01) were independently associated with PPI while preoperative aortic insufficiency (OR 0.52, p=0.01) and VSRR procedure compared to bio-Bentall (OR 0.40, p=0.01) were protective. Patients requiring PPI after ARR were not at increased risk of operative or long-term mortality compared to patients not requiring PPI (p=0.26), however those undergoing PPI suffered from significantly longer hospital length of stay (13 vs 7 days, p<0.001). The incidence of PPI after ARR remains low, particularly after VSRR. Preoperative conduction disturbance, prior AVR, and bicuspid AV are all associated with increased risk of PPI. While PPI is associated with longer length of stay, it is not associated with early or late mortality.