Permanent pacemaker implantation following mitral valve surgery. State-of-the-art scoping review

OBJECTIVES: This scoping review investigates the prevalence, indications, risk factors, timing, and outcomes related to permanent pacemaker implantation following mitral valve surgery. METHODS: A comprehensive search of PubMed, Embase, and Cochrane databases was conducted to identify studies on permanent pacemaker implantation after mitral valve surgery. Relevant articles discussing prevalence, indications, risk factors, optimal timing, device choice, and long-term dependency were included, prioritizing clinical studies and reviews published in the last two decades. RESULTS: The incidence of permanent pacemaker implantation after isolated mitral valve surgeries varies from 1% to 10%, with observation periods ranging from 2 to 12 days across centers. Atrioventricular block is the most common indication. Risk factors include older age, atrial fibrillation, reduced left ventricular function, and prior cardiac surgery. Patients undergoing mitral valve replacement face a higher risk compared to those having mitral valve repair, while minimally invasive surgery and left atriotomy approach are linked to a lower permanent pacemaker rate. Long-term pacemaker dependency ranges between 20% to 60%, with increased rates observed in patients with atrioventricular block or those operated in the setting of infective endocarditis. CONCLUSIONS: This review highlights the complex interplay of factors influencing permanent pacemaker implantation after mitral valve surgery. Future research should focus on strategies to reduce postoperative conduction abnormalities and better identify patients who may require PPM during long-term follow-up.