Rezan AKSOY, Deniz ÇEVİRME, Hakan HANÇER, Tolga BAS, Serdar DEMİR, Ali KARAGOZ, Murat Bulent RABUS

Aort ve Mitral Kapak Replasmanı Sonrası Kalıcı Kalp Pili İmplantasyonunun Risk Faktörleri ve Sonuçları

Bu çalışmada, triküspit anüloplasti (TAP) olan/olmayan mitral kapak ve aort kapak replasmanlarını takiben kalıcı kalp pili implantasyonu (KKPI) için risk faktörlerinin araştırılması amaçlandı. Bu çalışmada Ocak 2014'ten Aralık 2017'ye kadar eşzamanlı TAP olan ve/veya olmayan aort kapak ve mitral kapak replasmanı yapılan hastalar geriye dönük olarak analiz edildi. Çalışmaya toplam 179 ardışık hasta (%48.0 erkek; ortalama yaş 51.7±13.7 yıl) dahil edildi; 165 (%92.17) hasta KKPI olmayan grubda ve 14 (%7.82) hasta KKPI olan gruptaydı. Toplam 179 ardışık hastanın %48.0’i erkek ve ortalama yaş 51.7±13.7 yıldır. İki grup yaş, cinsiyet, vücut kitle indeksi (VKİ), diabetes mellitus (DM), hipertansiyon (HT), ejeksiyon fraksiyonu % (%EF) ve kardiyopulmoner baypas (KPB) süresi açısından farklılık göstermedi (p>0.05). KKPI grubunda daha küçük boyutlarda mekanik veya biyolojik aort kapakları vardı (p˂0.05), önemli ölçüde daha yüksek bazal atriyal fibrilasyon (AF) oranı mevcuttu (p˂0.05). Geç ölüm oranları KKPI olamayan grupta ve KKPI olan gruplarda sırasıyla %10.9, %35.7 idi (p<0.05). KPI grubunda >2+ postoperatif tricuspid yetersizliği (TY) anlamlı olarak daha yüksekti (p<0.05). Daha dar ve kalsifik aort köklerine bağlı olabilecek KKPI grubunda mekanik veya biyolojik aort kapak boyutları anlamlı olarak daha küçüktü. Başlangıç AF'si olan hastaların yüzdesi KKPI grubunda daha fazlaydı. KKPI uygulanan hastalarda anlamlı derecede yüksek olan >2+ postoperatif TY bir risk faktörü olarak kabul edilemez ancak anlamlı bir sonuçtur.

Anahtar Kelimeler:

aort kapak replasmanı, mitral kapak replasmanı, kalıcı pil implantasyonu

Risk Factors and Outcomes of Permanent Pacemaker Implantation Following Aortic and Mitral Valve Replacements

This study aimed to search risk factors for permanent pacemaker implantation (PPI) following mitral valve and aortic valve replacements with/without tricuspid annuloplasty (TAP). This study retrospectively analysed patients undergoing aortic valve and mitral valve replacements with/without concomitant TAP from January 2014 to December 2017. A total 179 consecutive patients were included into the study, 165 (92.17%) patients comprised no-PPI group and 14 (7.82%) comprised PPI group. A total 179 consecutive patients were 48.0% men; with the mean age 51.7±13.7 years. The two groups did not differ with respect to age, gender, body mass index (BMI), diabetes mellitus (DM), hypertension (HT), ejection fraction % (EF %) and the duration of cardiopulmonary bypass (CPB) (p>0.05). The PPI group had smaller sizes of mechanical or biological aortic valves (p˂0.05), with a significantly higher rate of baseline atrial fibrillation (AF) (p˂0.05). The late mortality rates were 10.9%, 35.7% in the no-PPI and the PPI groups, respectively (p<0.05). The PPI group had significantly higher > 2+ postoperative TR (p<0.05). The sizes of mechanical or biological aortic valves were significantly smaller in the PPI group, which may be due to the narrower and calcific aortic roots. The percentage of patients with a baseline AF was greater in the PPI group. The significantly higher incidence of >2+ postoperative TR among patients receiving PPIs can be deemed merely a result, but not a risk factor.

Keywords:

aortic valve replacement, mitral valve replacement, permanenet pacemaker implantation,

PDF

___

1. Emlein G, Huang SKS, Pires LA, Rofino K, Okike ON, Vander Salm TJ. Prolonged bradyarrhythmias after isolated coronary by-pass graft surgery. Am Heart J. 1993;126(1084):90.
2. Chung MK. Cardiac surgery: postoperative arrhythmias. Crit Care Med. 2000;28:136–44.
3. Boughaleb D, Mansourati J, Genet L, Barra J, Mondine P, Blanc JJ. Permanent cardiac stimulation after aortic valve replacement: incidence, predictive factors and long-term prognosis. Arch Mal Coeur Vaiss. 1994; 87:925–30.
4. Lipton IH, Cameron DA, David TE, Mackall J. A Morbidity of permanent pacing following valvular surgery. PACE. 1995;18(1768)
5. Leyva F, Qiu T, McNulty D, Evison F, Marshall H, Gasparini M. Long-term requirement for pace- maker implantation after cardiac valve replace- ment surgery. Heart Rhythm. 2017;14:529–34.
6. Wiggins NB, Chong DT, Houghtaling PL, Hussein AA, Saliba W, Sabik JF. Incidence, indications, risk factors, and survival of patients undergoing cardiac implantable electronic device implantation after open heart surgery. Europace. 2017;19:1335–42.
7. Zakhia Doueihi R, Leloux MF, De Roy L, Krémer R. Permanent cardiac pacing for prolonged second- and third-degree atrioventricular block complicating cardiac valve replacement. Acta Cardiol. 1992; 47:157–66.
8. Elahi M, Usmaan K. The bioprosthesis type and size influence the postoperative incidence of permanent pacemaker implantation in patients undergoing aortic valve surgery. J Interv Card Electrophysiol. 2006;15(2):113–8.
9. Sachweh JS, Vazquez-Jimenez JF, Schondube FA, et al. Twenty years’ experience with pediatric pacing: epicardial and transvenous stimulation. Eur J Cardiothorac Surg. 2000;17(4):455-61.
10. Al-Ghamdi B, Mallawi Y, Shafquat A, et al. Predictors of permanent pacemaker implantation after coronary artery bypass grafting and valve surgery in adult patients in current surgical era. Cardiol Res. 2016;7(4):123–9.
11. Turkkan C, Osmanov D, Yildirim E, et al. Bradyarrhythmia development and permanent pacemaker implantation after cardiac surgery. North Clin Istanb. 2018;5(4):288–94.
12. Moskowitz G, Hong KN, Giustino G, et al. Incidence and risk factors for permanent pacemaker implantation following mitral or aortic valve surgery. J Am Coll Cardiol. 2019;74(21):2607–20.
13. Nm VM, Sj H, Jong W, Domburg RT, Pw S, Jaegere PP. Persistent annual permanent pacemaker implantation rate after surgical aortic valve replacement in patients with severe aortic stenosis. Ann Thorac Surg. 2012; 94:1143–9.
14. Schurr UP, Berli J, Berdajs D, et al. Incidence and risk factors for pacemaker implantation following aortic valve replacement. Interact Cardiovasc Thorac Surg. 2010;11(5):556–60.
15. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guide- lines (Writing Committee to Revise the ACC/AHA/ NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008;51:1–62.
16. Brignole M, Auricchio A, Baron-Esquivias G et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA): The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34(29):2281–329.
17. Writing Committee Members, Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Heart Rhythm. 2019;16(9): e227–79.
18. Cardiac Pacemakers -Biological Aspects, Clinical Applications and Possible Complications. Edited by Mart Min, ISBN 978-953-307-639-3, 206 pages, Publisher: InTech, Chapters published September 06, 2011 under CC BY- NC-SA 3.0 license.
19. Raza SS, Li JM, John R, Chen LY, Tholakanahalli VN, Mbai M. Long-term mortality and pacing outcomes of patients with permanent pacemaker implan- tation after cardiac surgery. Pacing Clin Electrophysiol. 2011;34(3):331-8.
20. Jouan J, Mele A, Florens E, et al. Conduction disorders after tricuspid annuloplasty with mitral valve surgery: Implications for earlier tricuspid intervention. J Thorac Cardiovasc Surg. 2016;151(1):99–103.
21. Chi M-C, Hung K-C, Chang S-H, et al. Effect of permanent pacemaker implantation after valve surgery on long-term outcomes. Circ J. 2021;85(7):1027–34.
22. Kestenbaum B, Rudser KD, Shlipak MG, et al. Kidney function, electrocardiographic findings, and cardiovascular events among older adults. Clin J Am Soc Nephrol. 2007;2(3):501–8.
23. Mathew J, Katz R, St John Sutton M, et al. Chronic kidney disease and cardiac remodelling in patients with mild heart failure: results from the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) study. Eur J Heart Fail. 2012;14(12):1420-8.
24. Fukuda T, Hawley RL, Edwards JE. Lesions of conduction tissue complicating aortic valvular replacement. Chest. 1976;69(5):605–14.
25. Totaro P, Calamai G, Montesi G, Barzaghi C, Vaccari M. Continuous suture technique and impairment of the atrioventricular conduction after aortic valve replacement. J Card Surg. 2000;15(6):418–22.
26. Gillinov AM, Gelijns AC, Parides MK, et al. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med. 2015;372(15):1399–409.
27. Nair CK, Sketch MH, Ahmed I, Thomson W, Ryschon K, Woodruff MP. Calcific valvular aortic stenosis with and without mitral annular calcium. Am J Cardiol. 1987; 60:865–70.
28. Delling FN, Hassan ZK, Piatkowski G, et al. Tricuspid regurgitation and mortality in patients with transvenous permanent pacemaker leads. Am J Cardiol. 2016;117(6):988–92.
29. Höke U, Auger D, Thijssen J, et al. Significant lead-induced tricuspid regurgitation is associated with poor prognosis at long-term follow-up. Heart. 2014;100(12):960–8.
30. Al-Bawardy R, Krishnaswamy A, Bhargava M, et al. Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review: TR in patients with pacemakers and ICDs. Clin Cardiol. 2013;36(5):249–54.