Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality

R. Lorusso; J.M. Ravaux; F. Barili; E. Bidar; K. Vernooy; M. Di Mauro; A. Miceli; A. Parolari; A. Daprati; V. Myasoedova; F. Alamanni; C. De Vincentiis; E. Aime; F. Nicolini; G. Gonzi; A. Colli; G. Gerosa; M. De Bonis; G. Paglino; P. Della Bella; G.A. Dato; E. Varone; S. Sponga; M. Toniolo; A. Proclemer; U. Livi; G. Mariscalco; M. Cottini; C. Beghi; R. Scrofani; D. Foresti; F.P. Tritto; R. Gregorio; E. Villa; G. Troise; D. Pecora; F. Serraino; F. Jiritano; F. Rosato; E. Grasso; D. Paparella; L. Amorese; E. Vizzardi; M. Solinas; G. Arena; D. Maselli; C. Simon; M. Glauber; M. Merlo; GIROC Investigators

doi:10.1016/j.amjcard.2020.10.010

Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality

R. Lorusso, J.M. Ravaux^*, F. Barili, E. Bidar, K. Vernooy, M. Di Mauro, A. Miceli, A. Parolari, A. Daprati, V. Myasoedova, F. Alamanni, C. De Vincentiis, E. Aime, F. Nicolini, G. Gonzi, A. Colli, G. Gerosa, M. De Bonis, G. Paglino, P. Della BellaG.A. Dato, E. Varone, S. Sponga, M. Toniolo, A. Proclemer, U. Livi, G. Mariscalco, M. Cottini, C. Beghi, R. Scrofani, D. Foresti, F.P. Tritto, R. Gregorio, E. Villa, G. Troise, D. Pecora, F. Serraino, F. Jiritano, F. Rosato, E. Grasso, D. Paparella, L. Amorese, E. Vizzardi, M. Solinas, G. Arena, D. Maselli, C. Simon, M. Glauber, M. Merlo, GIROC Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Web of Science)

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.

Original language	English
Pages (from-to)	66-71
Number of pages	6
Journal	American Journal of Cardiology
Volume	138
DOIs	https://doi.org/10.1016/j.amjcard.2020.10.010
Publication status	Published - 1 Jan 2021

Keywords

aortic-valve-replacement
conduction
implantation
long-term survival
outcomes
IMPLANTATION
LONG-TERM SURVIVAL
CONDUCTION
AORTIC-VALVE-REPLACEMENT
OUTCOMES

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10.1016/j.amjcard.2020.10.010

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Lorusso, R., Ravaux, J. M., Barili, F., Bidar, E., Vernooy, K., Di Mauro, M., 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., ... GIROC Investigators (2021). Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality. American Journal of Cardiology, 138, 66-71. https://doi.org/10.1016/j.amjcard.2020.10.010

@article{28e418970975428ab1380e7d5e9e13f7,

title = "Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality",

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.",

keywords = "aortic-valve-replacement, conduction, implantation, long-term survival, outcomes, IMPLANTATION, LONG-TERM SURVIVAL, CONDUCTION, AORTIC-VALVE-REPLACEMENT, OUTCOMES",

author = "R. Lorusso and J.M. Ravaux and F. Barili and E. Bidar and K. Vernooy and {Di Mauro}, M. and A. Miceli and A. Parolari and A. Daprati and V. Myasoedova and F. Alamanni and {De Vincentiis}, C. and E. Aime and F. Nicolini and G. Gonzi and A. Colli and G. Gerosa and {De Bonis}, M. and G. Paglino and {Della Bella}, P. and G.A. Dato and E. Varone and S. Sponga and M. Toniolo and A. Proclemer and U. Livi and G. Mariscalco and M. Cottini and C. Beghi and R. Scrofani and D. Foresti and F.P. Tritto and R. Gregorio and E. Villa and G. Troise and D. Pecora and F. Serraino and F. Jiritano and F. Rosato and E. Grasso and D. Paparella and L. Amorese and E. Vizzardi and M. Solinas and G. Arena and D. Maselli and C. Simon and M. Glauber and M. Merlo and {GIROC Investigators}",

year = "2021",

month = jan,

day = "1",

doi = "10.1016/j.amjcard.2020.10.010",

language = "English",

volume = "138",

pages = "66--71",

journal = "American Journal of Cardiology",

issn = "0002-9149",

publisher = "Excerpta Medica, Elsevier Science",

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Lorusso, R , Ravaux, JM, Barili, F, Bidar, E , Vernooy, K , Di Mauro, M, 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, Della Bella, P, Dato, GA, Varone, E, Sponga, S, Toniolo, M, Proclemer, A, Livi, U, Mariscalco, G, Cottini, M, Beghi, C, Scrofani, R, Foresti, D, Tritto, FP, 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 & GIROC Investigators 2021, 'Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality', American Journal of Cardiology, vol. 138, pp. 66-71. https://doi.org/10.1016/j.amjcard.2020.10.010

TY - JOUR

T1 - Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality

AU - Lorusso, R.

AU - Ravaux, J.M.

AU - Barili, F.

AU - Bidar, E.

AU - Vernooy, K.

AU - Di Mauro, M.

AU - Miceli, A.

AU - Parolari, A.

AU - Daprati, A.

AU - Myasoedova, V.

AU - Alamanni, F.

AU - De Vincentiis, C.

AU - Aime, E.

AU - Nicolini, F.

AU - Gonzi, G.

AU - Colli, A.

AU - Gerosa, G.

AU - De Bonis, M.

AU - Paglino, G.

AU - Della Bella, P.

AU - Dato, G.A.

AU - Varone, E.

AU - Sponga, S.

AU - Toniolo, M.

AU - Proclemer, A.

AU - Livi, U.

AU - Mariscalco, G.

AU - Cottini, M.

AU - Beghi, C.

AU - Scrofani, R.

AU - Foresti, D.

AU - Tritto, F.P.

AU - Gregorio, R.

AU - Villa, E.

AU - Troise, G.

AU - Pecora, D.

AU - Serraino, F.

AU - Jiritano, F.

AU - Rosato, F.

AU - Grasso, E.

AU - Paparella, D.

AU - Amorese, L.

AU - Vizzardi, E.

AU - Solinas, M.

AU - Arena, G.

AU - Maselli, D.

AU - Simon, C.

AU - Glauber, M.

AU - Merlo, M.

AU - GIROC Investigators

PY - 2021/1/1

Y1 - 2021/1/1

N2 - 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.

AB - 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.

KW - aortic-valve-replacement

KW - conduction

KW - implantation

KW - long-term survival

KW - outcomes

KW - IMPLANTATION

KW - LONG-TERM SURVIVAL

KW - CONDUCTION

KW - AORTIC-VALVE-REPLACEMENT

KW - OUTCOMES

U2 - 10.1016/j.amjcard.2020.10.010

DO - 10.1016/j.amjcard.2020.10.010

M3 - Article

C2 - 33065081

SN - 0002-9149

VL - 138

SP - 66

EP - 71

JO - American Journal of Cardiology

JF - American Journal of Cardiology

ER -