Long-term impact of permanent cardiac pacing after surgical aortic valve replacement: systematic review and meta-analysis

ABSTRACT

Objectives

Permanent pacemaker (PPM) implantation after surgical aortic valve (SAVR) is associated with short- and long-term complications. However, the impact of PPM implantation on long-term mortality has not been fully established. The aim of this meta-analysis was to determine whether PPM post-SAVR increases the risk of mortality.

Methods

We searched Cochrane, MEDLINE, and EMBASE from inception to December 2020 for studies comparing mortality between patients who received PPM post-SAVR and those who did not. Random effects meta-analysis was performed to determine the effect of PPM on early and late mortality. The effect sizes were reported as hazard ratio (HR) with 95% confidence intervals.

Results

Three studies met criteria, which yielded a total of 9,105 patients. The most common indication was post-operative complete atrioventricular block. While there was no difference in early mortality between the PPM and no PPM groups (RR 1.19; 95%CI 0.20–7.08; I² = 23%), PPM implantation was shown to significantly increase late mortality (RR 1.49; 95%CI 1.25–1.77; I² = 0%).

Conclusion

The need for permanent pacemaker after surgically isolated aortic valve replacement is associated with increased risk of long-term mortality. This warrants further exploration on the effect of PPM on long-term mortality in patients receiving sutureless prostheses or transcatheter aortic valve implants.

Abbreviations

PPM Permanent PacemakerSAVR Surgical Aortic Valve Replacement

KEYWORDS:

• Valve
• pacemaker
• aortic
• SAVR
• TAVI

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Additionally, this paper was not funded.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

M El Diasty formulated the research question of the review. M Servito and WK conducted literature search. M Servito, W Khoury, and M El Diasty screened and shortlisted articles. M Servito and W Khoury performed article assessment and data extraction. M Servito performed statistical analysis. All authors reviewed the results. M Servito, W Khoury, and M El Diasty participated in writing the manuscript in discussion with A Baranchuk and D Payne.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.