Cardiac Pacing and Valvular Surgery

Abstract

Over a 17-year period (1970-1987) 75 patients, 3% of overall valvular surgery (VS) patients have been permanently paced at the time of VS (group 1), nine have been paced long after (group 2), 12 were already paced at the time of valve replacement (group 3), and 81 had a permanent pacing lead inserted during VS without further need for permanent pacing (group 4). Based on pre-, per- and post-operative clinical and electrocardiographic data we studied these four groups (GR). Aortic disease and especially calcified aortic stenosis (CAS) are the main valvular pathologies in all GR. The survival rate in GR 1 is lower than the survival rate of our overall VS PT5 due to older average ages and more severe cardiac conditions. In five patients GR 2 a myocardial pacing lead placed during VS was used long after for permanent stimulation. Patients in GR 3 were older than in other GR at the time of VS. The mortality was high in the patients operated on between 1973 and 1978 (average survived 3.5 years after pacing/2 years after VS) thus demonstrating the benefit of myocardial protection. For GR 4 the ratio of permanent lead implantation during VS was high in the late seventies (10%), it is now around 0.5%. In cases where the evolution of peroperative conduction disturbances is doubtful, it seems to us simpler to place a myocardial lead avoiding subsequent endocardial pacing if necessary, later, especially in patients with tricuspid disease.

Long-Term Atrioventricular Block Following Valve Surgery: Electrocardiographic and Surgical Predictors

“…comorbidities and age was observed [6,7]. Moreover, there has been no focus on type of surgery, namely single-valve or multi-valve surgery [8][9][10][11][12][13][14][15][16][17].…”

“…These latter studies reported the highest PM implantation incidence but have some limitations: there was no evaluation of preoperative electrocardiographic data, and considerable variability in terms of comorbidities and age was observed [6,7]. Moreover, there has been no focus on type of surgery, namely single-valve or multi-valve surgery [8][9][10][11][12][13][14][15][16][17].…”

Implantation of a Single Chamber Pacemaker in Patients with Triple Mechanical Valve Prosthesis: Utilization of Coronary Sinus Distal Branches to Stimulate the Left Ventricle

“…stimulation channels (right ventricle apex via tricuspid valve) are not commonly used because of the high risk of inducing a prosthetic valve blockage and/or the premature rupture of the stimulating lead. [1][2][3] The most practical solution remains right ventricle stimulation with an epicardial lead positioned directly on the right ventricle.…”

“…In patients with tricuspid mechanical valve prosthesis, a definitive pacemaker is usually implanted using an epicardial lead or during valve replacement intervention. [1][2][3] However, new leads specifically designed to stimulate the left ventricle via the coronary sinus recently have been introduced to the market. 4 We report the case of a 63-year-old patient affected by mitro-aortic valvulopathy with massive tricuspid regurgitation who had undergone a triple valve replacement with mechanical prosthesis.…”

Acknowledgements

“…The routine "prophylactic" placement of epimyocardial electrodes at the time of valve surgery has been suggested as a solution, with the option of connecting these electrodes to a pulse generator under local anesthesia at a later date. 2 This, however, does not overcome the problem of a high incidence of chronic complications from such leads, like high pacing thresholds and conductor fractures. Epimyocardial leads for permanent ventricular pacing are not always necessary following tricuspid valve replacement.…”