Does the Type of Prosthesis Influence the Incidence of Permanent Pacemaker Implantation Following Isolated Aortic Valve Replacement


  • Maqsood M. Elahi
  • Khalid A. Osman
  • Manoj Bhandari
  • Ramana Rao V. Dhannapuneni



Background: The incidence of conduction disorders requiring permanent pacing (PPM) in patients operated on for aortic valve replacement (AVR) has been reported to be 5.7%. However, perioperative risk predictors for PPM following AVR are not well characterized and debate exists regarding selection of the prosthesis-type most likely to minimize this incidence. The aim of the study was to assess whether the type of the prosthesis used influences the prevalence of PPM following aortic valve replacement.

Methods: A total of 782 consecutive patients with predominant aortic stenosis accepted for isolated non-emergent AVR were studied over a 3 year period; of which 305 patients (Group A) received mechanical prostheses, 335 received stented tissue prostheses (Group B), and the remaining 142 received stentless tissue valves (Group C). A stepwise logistic regression analysis was used to identify the independent predictors for PPM and statistical significance was accepted at a level of P < .05.

Results: Univariate and multivariate analyses showed a significant relationship between the preoperative factors (poor ejection fraction <35%; P < .001), left atrial enlargement (LAE; P < .001) and left bundle branch block (LBBB; P < .001), the perioperative variables (bypass time >100 minutes with x-clamp time >70 minutes; P < .001) and the incidence of PPM.

Conclusions: The proposed predictive model correlated highly with actual pacemaker use, suggesting that the requirement for PPM results from either operative trauma or increased ischemic burden and the incidence of PPM is independent of prosthesis-type implanted.


Blais C, Dumesnil JG, Baillot R, Simard S, Doyle D, Pibarot P. 2003. Impact of valve prosthesis-patient mismatch on short term mortality after aortic valve replacement. Circulation 108:983-8.nBoughaleb D, Mansourati J, Genet L, Barra J, Mondine P, Blanc JJ. 1994. Permanent cardiac stimulation after aortic valve replacement: incidence, predictive factors and long-term prognosis. Arch Mal Coeur Vaiss 87:925-30.nBraunwald E. 2000. Aortic valve replacement; an update at the turn of the millennium. Eur J Heart 21:1032-3.nBreisch EA, White FC, Bloor CM. 1984. Myocardial characteristics of pressure overload hypertrophy. A structural and functional study. Lab Invest 51:333-42.nDel Rizzo DF, Nishimura S, Lau C, Sever J, Goldman BS. 1996. Cardiac pacing following surgery for acquired heart disease. J Cardiovasc Surg 11:332-40.nGerber IL, Stewart RA, Hammett CJ, et al. 2003. Effect of aortic valve replacement on C-reactive protein in nonrheumatic aortic stenosis. Am J Cardiol 92:1129-32.nGordon RS, Ivanov J, Cohen G, Ralph-Edwards AL. 1998. Permanent cardiac pacing after a cardiac operation: predicting the use of permanent pacemakers. Ann Thorac Surg 66:1698-704.nJalil JE, Doering CW, Janicki JS, et al. 1989. Fibrillar collagen and myocardial stiffness in the intact hypertrophied rat left ventricle. Circ Res 64:1041-50.nKeefe DL, Griffin JC, Harrison DC, Stinson EB. 1985. Atrioventricular conduction abnormalities in patients undergoing isolated aortic or mitral valve replacement. Pacing Clin Electrophysiol 8:393-8.nPfeiffer MA, Braunwald E. 1990. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation 81:1161-72.nSia YT, Lapointe N, Parker TG, et al. 2002. Beneficial effects of long-term use of the antioxidant probucol in heart failure in rat. Circulation 105:2549-55.nVerdecchia P, Schillaci C, Borgoni C, et al. 1998. Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation 273:2161-8.nGoldman BS, David TE, Del Rizzo DF, Sever J, Bos J. 1994. Stentless porcine bioprosthesis for aortic valve replacement. J Cardiovasc Surg 35:105-10.nLimongelli G, Ducceschi V, D'Andrea A, et al. 2003. Risk factors for pacemaker implantation following aortic valve replacement: a single centre experience. Heart 89:901-4.nMorisco C, Sadoshima J, Trimarco B, Arora R, Vatner DE, Vatner SF. 2003. Is treating cardiac hypertrophy salutary or detrimental: the two faces of Janus. Am J Physiol Heart Circ Physiol 284:H1043-7.nMuiesan ML, Salvetti M, Rizoni D, Castellano M, Donato F, Agabiti-Rosei E. 1995. Association of change in left ventricular mass with prognosis during long-term anti-hypertensive treatment. J Hypertens 13:1091-5.nElahi MM, Lee D, Bhandari M, Dhannapuneni RV, Sosnowski AW. 2005. Permanent pacemaker implantation after valve surgery: assessing its need in early postoperative period: our experience in a tertiary centre. Br J Cardiol (in press).nKvidal P, Bergstorm R, Malm T, et al. 2000. Long term follow up of morbidity and mortality after aortic valve replacement with mechanical valve prostheses. Eur Heart J 21:1099-111.nLewis JW Jr, Webb CR, Pickard SD, Lehman J, Jacobsen G. 1998. The increased need for a permanent pacemaker after reoperative cardiac surgery. J Thorac Cardiovasc Surg 116:74-81.n



How to Cite

Elahi, M. M., Osman, K. A., Bhandari, M., & Dhannapuneni, R. R. V. (2005). Does the Type of Prosthesis Influence the Incidence of Permanent Pacemaker Implantation Following Isolated Aortic Valve Replacement. The Heart Surgery Forum, 8(6), E396-E400.