Observational studyEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2025
Implications of pacemaker implantation after aortic valve surgery for endocarditis: a nationwide study†.
Observational study in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Reconstruction of the Aorto-Mitral Curtain in Complex Infective Endocarditis: A Contemporary Narrative Review of the Commando Procedure.Reviews in cardiovascular medicine · 2026Review
- Influence of Surgical Timing on the Risk of Permanent Pacemaker Implantation in Acute Aortic Valve Endocarditis.Medicina (Kaunas, Lithuania) · 2026Observational
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Authors and funding
5 authors.
Funding
Abstract
objectivesInfective endocarditis (IE) is associated with a high risk of atrioventricular block and surgery adds to the risk of receiving a permanent pacemaker. The clinical impact of pacemaker implantation in IE patients is insufficiently studied. Our objective was to analyse long-term clinical outcomes in patients who receive a permanent pacemaker after IE surgery.
methodsWe conducted a nationwide observational cohort study, including all patients undergoing surgery for aortic valve IE in Sweden 1997-2022. The exposure group was patients who received a permanent pacemaker within 30 days of surgery. We used inverse probability of treatment weighting to account for inter-group differences and flexible parametric models to estimate hazards and cumulative incidences. Outcomes were all-cause mortality, heart failure and reinfection in the prosthetic valve.
resultsAmong 2175 patients who underwent surgery for aortic valve endocarditis, 168 (8%) received a permanent pacemaker. The mean age was 59 years; 18% were female. During a mean follow-up of 8.0 years (maximum 26 years), 822 patients (38%) died. At 15 years, the cumulative incidence of all-cause mortality was 60% versus 50% in the pacemaker versus the no pacemaker group; for heart failure, it was 21% versus 16%. We found no association of pacemaker implantation with mortality [hazard ratio (HR) 1.17; 95% confidence interval (CI) 0.86-1.58], heart failure (HR 1.42; 95% CI 0.89-2.29) or reinfection (HR 0.85; 95% CI 0.50-1.45).
conclusionsPacemaker implantation after surgery for aortic valve IE is common but was not associated with an increased risk of death, heart failure or reinfection. Although pacemaker need suggests more advanced disease, these results show that lifesaving surgery is not importantly jeopardised by the need for a pacemaker.
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