ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Permanent pacemaker implantation after open heart surgery
Hasan Basri Erdoğan 1, Adil Polat 1, Hasan Ardal 1, Hakan Akbayrak 2, Yücel Özen 1, Suat Nail Ömeroğlu 1, Kaan Kırali 1, Esat Akıncı1
1Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul
2Van Yüksek İhtisas Kalp Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Van
Background: Permanent pacemaker (PP) implantation is rarely required after open heart surgery. A retrospective analysis of patients operated within last 10 years was performed to determine the frequency and risk factors.

Methods: Forty-three of patients, who were operated within the last 10 years in our clinic, required PP implantation. Thirteen (30%), (10 males, 3 females; mean age 66.8±8.1; range 43 to 77 years) of these were operated for coronary artery disease (CAD), 24 (55%), (10 males, 14 females; mean age 52.5±5.6; range 16 to 73 years) for acquired valvular heart disease (AVD) and 6 (13%), (5 males, 1 female; mean age 11.1±10.8; range 3 to 32 years) for congenital heart disease. Eight of the CAD patients had AV block preoperatively. Nineteen of these patients had aortic valve replacement (AVR), 2 had reoperation for mitral valve replacement (MVR), 2 had AVR + MVR and 1 had MVR and CABG. Indications for PP implantation were; persistent complete AV block lasting for 10 days postoperatively, atrial fibrillation/ flutter with slow ventricular response leading to hemodynamic compromise and paroxysmal atrial fibrillation leading to sinusoidal arrest >3 seconds.

Results: PP implantation was required for persistence of preoperatively existing complete A-V block in 8 patients and for the new onset A-V block in 35 patients. Mean interval from operation to implantation was 10.8±4.3 days. Mean times of intensive care unit stay and hospital stay were 42.6±14.6 hours and 16.8±4.7 days respectively. Mean follow- up time was 23.1±18.3 months. In long term, one patient had pace-maker battery protrusion, one had pulmonary arterial thromboembolism. During follow-up, 36 patients were in NYHA (New York Heart Association) Class I, 5 were Class II.

Conclusion: Preoperative estimation of conduction defects may effect the surgical plan directly. Detailed risk scoring systems are essential to guide the surgical team. In long term follow-up, permanent pacemaker implantation does not affect the functional capacity adversely.

Keywords : Pacemaker; arrythmia; cardiac surgery
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