Document Detail


The increased need for a permanent pacemaker after reoperative cardiac surgery.
MedLine Citation:
PMID:  9671900     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The requirement for permanent pacemaker implantation after most initial cardiac surgical procedures generally is less than 3%. To identify the incidence and factors related to permanent pacemaker need after repeat cardiac surgery, we retrospectively studied 558 consecutive patients undergoing at least one repeat cardiac operation. METHOD: Univariable and multivariable analyses of comorbidity, preoperative catheterization values, and operative data were performed to identify factors related to pacemaker implantation. RESULTS: In this group, 54 patients (9.7%) required a permanent pacemaker. A multivariable model showed a relationship between a permanent pacemaker and tricuspid valve replacement/annuloplasty associated with aortic/mitral valve replacement, preoperative endocarditis, increasing number of reoperations, the degree of hypothermia during cardiopulmonary bypass, and advanced age. Additional univariable predictors of pacemaker need included multiple valve replacement, increased cardiopulmonary bypass and aortic crossclamp times, and aortic valve replacement. Over 90% of patients who have or have not received permanent pacemaker implantation were in New York Heart Association class I to II, with a mean follow-up time of 6 years. Kaplan-Meier survival curves were statistically similar for both groups at 5 and 10 years after the operation. CONCLUSION: Permanent pacemaker implantation was required in 9.7% of patients undergoing repeat cardiac surgery. This represented approximately a fourfold increase compared with similar primary operations reported in other series. Factors strongly related to this need included valve replacement, preoperative endocarditis, number of reoperations, advanced age, and degree of hypothermia during cardiopulmonary bypass. The need for a permanent pacemaker after reoperations did not result in significant long-term impairment of functional status or longevity compared with those who did not require a permanent pacemaker.
Authors:
J W Lewis; C R Webb; S D Pickard; J Lehman; G Jacobsen
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  116     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1998 Jul 
Date Detail:
Created Date:  1998-08-03     Completed Date:  1998-08-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  74-81     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiac and Thoracic Surgery, Henry Ford Hospital, Detroit, Mich 48202, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Arrhythmias, Cardiac / etiology,  mortality,  therapy*
Cardiac Pacing, Artificial*
Cardiac Surgical Procedures / adverse effects*
Child
Child, Preschool
Female
Follow-Up Studies
Heart Diseases / surgery
Humans
Male
Middle Aged
Multivariate Analysis
Postoperative Complications / etiology,  mortality,  therapy*
Reoperation
Retrospective Studies
Survival Rate
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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