THE INCREASED NEED FOR A PERMANENT PACEMAKER AFTER REOPERATIVE CARDIAC-SURGERY

Objective: The requirement for permanent pacemaker implantation after most initial cardiac surgical procedures generally is less than 3%, To identify the incidence and factors related to permanent pacemaker wee d after repeat cardiac surgery, we retrospectively studied 558 consecu tive patients undergoing at least one repeat cardiac operation, Method : Univariable and multivariable analyses of comorbidity, preoperative catheterization values, and operative data were performed to identify factors related to pacemaker implantation, Results: In this group, 54 patients (9.7%) required a permanent pacemaker, A multivariable model showed a relationship between a permanent pacemaker and tricuspid valv e replacement/annuloplasty associated,with aortic/mitral valve replace ment, preoperative endocarditis, increasing number of reoperations, th e degree of hypothermia during cardiopulmonary bypass, and advanced ag e. Additional univariable predictors of pacemaker need included multip le valve replacement, increased cardiopulmonary bypass and aortic cros sclamp times, and aortic valve replacement. Over 90% of patients who h ave or have not received permanent pacemaker implantation were in New York Heart association class I to II, with a mean follow-up time of 6 years. Kaplan-Meier survival curves were statistically similar for bot h groups at 5 and 10 years after the operation. Conclusion: Permanent pacemaker implantation was required in 9.7% of patients undergoing rep eat cardiac surgery, This represented approximately a fourfold increas e compared with similar primary operations reported in other series. F actors strongly related to this need included valve replacement, preop erative endocarditis, number of reoperations, advanced age, and degree of hypothermia during cardiopulmonary bypass, The need for a permanen t pacemaker after reoperations did not result, in significant long-ter m impairment of functional status or longevity compared with those who did not require a permanent pacemaker.