瓣膜置换术后患者需要安置起搏器治疗的危险因素分析

Risk factors of permanent pacemaker implantation after valve replacement surgery

目的探讨心脏外科直视下瓣膜置换术后接受永久起搏器植入(PMI)的相关危险因素。方法收集本院2013年1月至2016年1月换瓣术后植入起搏器患者的临床资料,通过单因素及回归模型分析其相关预测因子。结果共收集5 320例换瓣患者,其中129例术后植入了起搏器,排除55例换瓣术前具有起搏指征、术后植入心脏再同步化起搏或除颤器的患者,并除外12例术前永久或持续性心房颤动术后因长RR间期接受PMI者,剩下62例换瓣术后行PMI患者作为观察组(PMI组),换瓣术后未行PMI患者作为对照组(NPMI组),PMI组平均住院日明显高于NPMI组[(34.5±21.2)d VS(16.8±8.6)d,P<0.01],经多变量二元Logistic回归分析提示单纯主动脉瓣置换术(AVR)(P<0.05,OR 2.24,95%CI 1.20~4.17)、换瓣术合并室间隔缺损(VSD)修补术(P<0.05,OR 6.78,95%CI 1.98~23.19)或合并主动脉根部及大血管手术(P<0.05,OR4.14 95%CI 1.42~12.04)为术后PMI独立危险因素。结论单纯AVR、换瓣术合并VSD修补术及换瓣合并主动脉根部及大血管手术为换瓣术后PMI的独立危险因素。

Objective To determine the risk factors of permanent pacemaker implantation （PMI） after valve re- placement surgery. Methods We conducted a retrospective study of all consecutive patients underwent PMI after valvular replacement surgery from January 2013 to January 2016. Univariate analyses and logistic regression were performed to identify variables independently associated with PMI after valve replacement surgery. Results Of a total of 5320 consecutive patients underwent valve surgery at our institution between January 2013 and January 2016, 129 （2.42 %） patients had received a permanent pacemaker after the surgery. Eliminating 55 patients with in- dications of PMI preoperation and 12 patients with permanent or long-standing persistent atrial fibrillation before surgery, implantable defibrillators or cardiac resynchronization therapy devices （CRTDs） post operation. The remai- ning 62 patients were identified and included in the study. In univariate analyses and multivariate analysis, Isolated aortic valve replacement（AVR） （P〈0.05, OR 2.24, 95%CI 1.20-4.17）, valve replacement combine ventricular septal defect （VSD） repair （P〈0.05,OR 6.78, 95% CI 1,98-23.19）, and valve replacement with aortic root and arch surgery （P〈0.05, OR4.14, 95 % CI 1.42-12.04） were significant statistical different risk factors associated with PMI after valve replacement surgery. Conclusions Isolated AVR, valve replacement concomitant VSD re- pair, and aortic root and arch surgery are the independent predictors of PMI after valve replacement surgery.