Incidence and Risk Factors for Permanent Pacemaker Implantation Following Mitral or Aortic Valve Surgery

Gil Moskowitz, Kimberly N. Hong, Gennaro Giustino, A. Marc Gillinov, Gorav Ailawadi, Joseph J. DeRose, Alexander Iribarne, Alan J. Moskowitz, Annetine C. Gelijns, Natalia N. Egorova

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


Background: Risk factors for post-operative conduction disturbances after cardiac valve surgery requiring a permanent pacemaker (PPM) are poorly characterized. Objectives: The aim of this study was to investigate the timing and risk factors for PPM implantation after mitral or aortic valve surgery. Methods: All patients who underwent open aortic or mitral valve surgery between January 1996 and December 2014 were reviewed using New York State's mandatory hospital discharge database. Patients with prior cardiac surgery or pre-existing PPM were excluded. The primary endpoint was PPM implantation within 1 year. Results: Among 77,882 patients, 63.8% (n = 49,706) underwent aortic valve replacement (AVR), 18.9% (n = 14,686) underwent mitral valve replacement (MVR), 10.5% (n = 8,219) underwent mitral valve repair (MVr), 5.4% (n = 4,202) underwent AVR plus MVR, and 1.4% (n = 1,069) underwent AVR plus MVr. The 1-year PPM implantation rate was 4.5% after MVr, 6.6% after AVR, 9.3% after AVR plus MVr, 10.5% after MVR, and 13.3% after AVR plus MVR (p < 0.001). Across all groups, the majority of PPMs were implanted during the index hospitalization (79.9%). MVr was associated with the lowest risk for PPM and AVR plus MVR with the highest risk. Older age, history of arrhythmias, pre-operative conduction disturbances, and concomitant index procedures were associated with increased risk for PPM during the index hospitalization. Conversely, beyond 30 days, chronic comorbidities were associated with increased risk for PPM. Conclusions: Conduction disturbances requiring PPM remain a common adverse event after valve surgery. Identifying patients at risk for PPM will help facilitate perioperative planning and inform clinical decision making regarding post-operative rhythm surveillance.

Original languageEnglish
Pages (from-to)2607-2620
Number of pages14
JournalJournal of the American College of Cardiology
Issue number21
StatePublished - 26 Nov 2019


  • aortic valve
  • conduction disorders
  • coronary artery bypass grafting
  • mitral valve
  • permanent pacemaker
  • surgical ablation procedure


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