Permanent pacemaker placement following valve surgery is not independently associated with worse outcomes

Commentary: If you start me up…I may never stop?

“…Furthermore, pacemaker dependency after device implantation may also play an important role in distant survival. 6 The work by Bianco and colleagues 7 from the University of Pittsburgh presented in the current issue of the Journal adds valuable data to this controversy and suggests that when adjusted for patient characteristics, PPM implantation after isolated valve or valve and coronary surgery does not affect distal survival. Although the authors present a large clinical cohort, the results and conclusions of the study need to be evaluated through a prism of several methodologic limitations.…”

Commentary: Permanent pacemaker implantation after cardiac surgery: Are we getting distracted by the usual suspects?

“…PPM-related complications cannot have simply disappeared in the study by Bianco and colleagues. 1 Hence, some other clinical factors might have played a role.…”

“…As always in medicine, the central question is not “Is this treatment good?” but rather, “Is this treatment good for this patient?” The message from Bianco and colleagues 1 is very important because it applies to the most common patients that cardiac surgeons operate on in their daily practice, and at least for the first few years after surgery. However, it should not lead us to underestimate the potential implications of postoperative PPM implantation in different—but equally important—patient populations in which improving the long-term outcomes is of paramount importance.…”

“…Filippo Rapetto, MD, and Vito D. Bruno, MD, PhD Arrhythmias requiring permanent pacemaker (PPM) implantation are recognized complications after cardiac surgery. Bianco and colleagues 1 report their analysis of the influence of postoperative PPM implantation on clinical outcomes following isolated and combined valve surgery at their institution.…”

“…but rather, "Is this treatment good for this patient?" The message from Bianco and colleagues 1 is very important because it applies to the most common patients Evaluating the influence of pacemaker implantation after cardiac surgery is challenging. Many important confounders and different times of exposure might have relevant influence on the outcomes.…”