Incidence and predictors of permanent pacemaker implantation after surgical aortic v alve replacement: Data of the Netherlands Heart Registration (NHR)

Justine M. Ravaux*, Sander M. J. Van Kuijk, Michele Di Mauro, Kevin Vernooy, Elham Bidar, Silvia Mariani, Giulia Actis Dato, Arnoud W. Van't Hof, Leo Veenstra, Suzanne Kats, Saskia Houterman, Jos G. Maessen, Roberto Lorusso, Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration

*Corresponding author for this work

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Objective Permanent pacemaker implantation (PPI) after surgical aortic valve replacement (SAVR) remains a frequent complication. Predictors, however, have been mainly investigated in single-center studies. Therefore, nationwide data were used to identify patients-and procedural risk factors for postoperative PPI. Materials and Methods Data were retrospectively collected from the Netherlands Heart Registration (NHR). Patients enrolled in the NHR undergoing isolated SAVR from 2013 to 2019 were analyzed. Primary endpoint was in-hospital PPI during hospitalization after SAVR. Results From the NHR database, 5600 patients with symptomatic aortic valve stenosis were included in the study. Crude incidence of post-SAVR PPI was 4.0%. Backward regression analysis identified previous cardiac surgery (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.18-2.76), extra-corporeal circulation time (OR: 1.01; 95% CI: 1.00-1.01), vasopressor use (OR: 2.66; 95% CI: 1.79-3.96) and in-hospital cardiac conduction abnormalities (OR: 4.48; 95% CI: 3.36-5.98) as potential predictors for PPI. Across the time, PPI after SAVR significantly increased (OR: 1.11; 95% CI: 1.03-1.21). Conclusions From this nationwide analysis, PPI after SAVR remains a low but increasingly frequent complication. Several predictive factors for postoperative PPI after SAVR have been identified and might be useful for patient informed consent about potential adverse event rate.

Original languageEnglish
Pages (from-to)3519-3527
Number of pages9
JournalJournal of Cardiac Surgery
Issue number10
Early online date11 Jul 2021
Publication statusPublished - Oct 2021


  • aortic stenosis
  • permanent pacemaker implantation
  • surgical aortic valve replacement

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