1. Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality
- Author
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Giroc Investigators, Andrea Colli, Ezio Aime, Egidio Varone, Domenico Paparella, Michele De Bonis, Giuseppe Arena, Francesco Alamanni, Roberto Scrofani, Paolo Della Bella, Francesco Paolo Tritto, Emmanuel Villa, Elena Grasso, Giovanni Troise, Fabio Barili, Veronika A. Myasoedova, Caterina Simon, Elham Bidar, Kevin Vernooy, Francesco Rosato, Antonio Miceli, Enrico Vizzardi, Mattia Glauber, Domenico Pecora, Marzia Cottini, Sandro Sponga, Giovanni Mariscalco, Carlo De Vincentiis, Roberto Lorusso, Cesare Beghi, Daniele Maselli, Filiberto Serraino, Alessandro Parolari, Davide Foresti, Francesco Nicolini, Gianluca Gonzi, Lilla Amorese, Mauro Toniolo, Alessandro Proclemer, Gabriele Paglino, Guglielmo Mario Actis Dato, Maurizio Merlo, Rosario Gregorio, Michele Di Mauro, Andrea Daprati, Justine M Ravaux, Gino Gerosa, Ugolino Livi, Marco Solinas, Federica Jiritano, Lorusso, R., Ravaux, J. M., Barili, F., Bidar, E., Vernooy, K., Mauro, M. D., Miceli, A., Parolari, A., Daprati, A., Myasoedova, V., Alamanni, F., De Vincentiis, C., Aime, E., Nicolini, F., Gonzi, G., Colli, A., Gerosa, G., De Bonis, M., Paglino, G., Bella, P. D., Dato, G. A., Varone, E., Sponga, S., Toniolo, M., Proclemer, A., Livi, U., Mariscalco, G., Cottini, M., Beghi, C., Scrofani, R., Foresti, D., Tritto, F. P., Gregorio, R., Villa, E., Troise, G., Pecora, D., Serraino, F., Jiritano, F., Rosato, F., Grasso, E., Paparella, D., Amorese, L., Vizzardi, E., Solinas, M., Arena, G., Maselli, D., Simon, C., Glauber, M., Merlo, M., CTC, MUMC+: MA Med Staf Spec CTC (9), RS: Carim - V04 Surgical intervention, MUMC+: MA Med Staf Artsass CTC (9), Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: Carim - H01 Clinical atrial fibrillation, and RS: Carim - H06 Electro mechanics
- Subjects
Male ,Pacemaker, Artificial ,030204 cardiovascular system & hematology ,Postoperative Complications ,0302 clinical medicine ,Aortic valve replacement ,80 and over ,Sinus rhythm ,implantation ,Coronary Artery Bypass ,Atrioventricular Block ,Permanent pacemaker ,cardiac surgery ,mortality ,pacemaker dependency ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,OUTCOMES ,Hazard ratio ,Cardiac Pacing, Artificial ,Middle Aged ,Cardiac surgery ,Pacemaker ,medicine.anatomical_structure ,Artificial ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Aged ,Bradycardia ,Humans ,Proportional Hazards Models ,Retrospective Studies ,Cardiac Surgical Procedures ,Mortality ,Artery ,medicine.medical_specialty ,aortic-valve-replacement ,conduction ,03 medical and health sciences ,Internal medicine ,medicine ,Proportional hazards model ,business.industry ,LONG-TERM SURVIVAL ,Retrospective cohort study ,medicine.disease ,030228 respiratory system ,Cardiac Pacing ,business ,Complication - Abstract
Permanent pacemaker implantation (PPI) represents a rare complication after cardiac surgery, with no uniform agreement on timing and no information on follow-up. A multi-center retrospective study was designed to assess pacemaker dependency (PMD) and long-term mortality after cardiac surgery procedures. Between 2004 and 2016, PPI-patients from 18 centers were followed. Time-to-event data were evaluated with semiparametric regression Cox models and semiparametric Fine and Gray model for competing risk framework. Of 859 (0.90%) PPI-patients, 30% were pacemaker independent (PMI) at 6 months. PMD showed higher mortality compared with PMI (10-year survival 80.1% +/- 2.6% and 92.2% +2.4%, respectively, log-rank p-value < 0.001) with an unadjusted hazard ratio for death of 0.36 (95% CI 0.20 to 0.65, p< 0.001 favoring PMI) and an adjusted hazard ratio of 0.19 (95% CI 0.08 to 0.45, p< 0.001 with PMD as reference). Crude cumulative incidence function of restored PMI rhythm at follow-up at 6 months, 1 year and 12 years were 30.5% (95% CI 27.3% to 33.7%), 33.7% (95% CI 30.4% to 36.9%) and 37.2% (95% CI 33.8% to 40.6%) respectively. PMI was favored by preoperative sinus rhythm with normal conduction (SR) (HR 2.37, 95% CI 1.65 to 3.40, p< 0.001), whereas coronary artery bypass grafting and aortic valve replacement were independently associated with PMD (HR 0.63, 95% CI 0.45 to 0.88, p = 0.006 and HR 0.807, 95% CI 0.65 to 0.99, p = 0.047 respectively). Time-to-implantation was not associated with increased rate of PMI. Although 30% of PPI-patients are PMI after 6 months, PMD is associated with higher mortality at long term. (C) 2020 The Author(s). Published by Elsevier Inc.
- Published
- 2021
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