Assessment of the need pacemaker implantation following aortic valve replacement with combined cardiac surgery

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Aim. To evaluate the risk factors for the development of cardiac conduction disorders and to determine their significance in temporary and permanent pacemaker implantation in patients after surgical aortic valve replacement and other combined cardiac surgical interventions. Material and methods. The analysis of patients who underwent surgical aortic valve replacement and other combined cardiac surgical interventions for the period from January 2018 to May 2023 in Krasnoyarsk Regional Clinical Hospital was performed. Results. The correlation between the occurrence of atrioventricular block (AVB) of II-III degree and sinus node dysfunction (SND) that required temporary pacemaker and permanent pacemaker implantation in patients after surgical prosthesis of aortic valve and other combined cardiac surgical interventions was determined. After AVR and other combined cardiac interventions atrial fibrillation (AF) was detected in 107 (44.6%) patients, left bundle branch block (LBBB) and right bundle branch block (RBBB) in 8 (3.3%) patients, and first-degree AV block in 12 (5.0%) patients. The need for temporary pacemaker after surgical prosthetic aortic valve and other combined cardiac surgical interventions was in 79 (45.4%) patients. 76 (96.2%) patients underwent TCP within 2 days after surgical treatment and 3 (3.8%) patients within 72 hours. According to single-factor analysis, 4 important reasons for required temporary pacemaker were identified: atrial fibrillation (OR=2,47, 95% CI=1,31-4,46, p=0,005), age older than 58.5 years (OR=2,52, 95% CI=1,29-4,93, p=0,006), glomerular filtration rate less than 77 ml/min (OR=2,12, 95% CI =1,08-4,17, p=0,028) and atrial tachycardia (OR=8,00, 95% CI=1,04-67,92, p=0,046). Рermanent pacemaker implantation was performed in 12 (6.7%) patients, 11 (91.7%) due to complete AVB and 1 (8.3%) patient due to SVD development. Pacemaker implantation after cardiac surgery was performed in 8 (66.7%) patients from 5 to 8 days, 3 (25.0%) patients from 10 to 15 days, and 1 (8.3%) patient after 23 months. According to regression analysis, a significant sign indicating a high risk of pacemaker implantation — presence of baseline left bundle branch block (OR= 6,32, 95% CI=1,09-36,70, p=0.020). Conclusion. The identified risk factors for conduction disturbances after aortic valve replacement and other cardiac surgical interventions can be used for timely conduction and implantation of a permanent pacemaker.

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