Pace maker requirement after AV and ascending aorta graft

[bdryer]

Good day

After AV and an ascending aorta graft, what is the percentage chance that a pace maker may be required?

I'm 55 and athletic. Does my age and athletic life style reduce the probability of requiring a pace maker after surgery?

 

[epstns]

As I understand it (and I just had this discussion with my surgeon a couple of days ago) the real driver as to whether or not a patient will require a pacemaker is whether any of the nerves that carry the electronic impulses across the heart are damaged in the procedure. They can't know ahead of time, and my surgeon (Dr. McCarthy at Northwestern in Chicago) indicated that perhaps 4 to 5% of his patients require pacemakers.

My mother had one due to AFIB. Didn't really cramp her style, so I can't be worried about that. (With surgery on March 1, I have enough other things to worry about. . . )

 

[Philip B]

Pacemaker

Pacemaker

It's pretty common practice to be attached to a pacemaker as the surgical procedure stuff is wrapped-up. In many cases, this practice is done to have everything in place in case it's needed. Having the pacemaker wires pulled post-op is one of those unpleasant and uncomfortable issues we faced.

Perhaps someone has researched some percentage figures concerning how many people experience permanent post-op rhythm problems and require a pacemaker.

-Philip

 

[Duff Man]

In this diagram you can see where the bundle of his and the av node have a connection that goes right by the aortic valve... apparently if that gets nicked, it's time for a pacemaker.

 

[normofthenorth]

My vague impression is that it's much more common to use those PM wires in the early days, than it is to leave the hospital with a permanent PM.

 

[bdryer]

How many folks here have gone in for initial replacement of of the AV with an ascending aorta graft and came out requiring a pace maker? Were you athletic and healthy?

It would seem the surgeon would have to make a drastic error to cut into the bundle of his and the av node, especially on an initial AV replacement.

Duff Man, thanks for posting the diagram! Defiantly provides a visual to my question.

 

[Greg a]

You may want to ask that here at the ICD support site
http://icdsupportgroup.org/board/index.php

 

[mainframe]

I got a pace maker a couple of weeks after my 2nd AVR. I'm assuming it was because of my CHF due to the bovine tissue valve failing so fast and the severe regurgataion that probably damaged my heart. My ejection fraction post surgery was only 28 though it's improved to 45 at last echo with the drugs I take. Seems I'm pacing about 98 percent of the time. The way Stanford hooked up the pacemaker 1 of the wire requires a higher voltage to be effective and the battery seems to running out in the next few months and I'll have to get another.

 

[daveguy14]

As I understand it (and I just had this discussion with my surgeon a couple of days ago) the real driver as to whether or not a patient will require a pacemaker is whether any of the nerves that carry the electronic impulses across the heart are damaged in the procedure. They can't know ahead of time, and my surgeon (Dr. McCarthy at Northwestern in Chicago) indicated that perhaps 4 to 5% of his patients require pacemakers.

This is my understanding as well. So, not zero, but still unlikely for any given patient. Not sure if it has anything to do with any patient characteristics (but my uneducated guess is that it doesn't).

 

[Mentu]

My experience was the same as Steve's and Daves. If a you have no issues that require a pacemaker before surgery, the primary cause of needing one later is that the AV conduction bundle has been damaged during surgery; this is the one of the sites in the heart that controls rhythm. It is located just below the Aortic Valve and can be damaged when the new valve is sewn in place. This does not happen very often but it is a risk of surgery. If one of the needles used to secure the new valve pierces the AVCB, the patient will need a pacemaker. Still, this is not a common problem because good surgeons are quite aware of this possibility. In the Texas Heart Institute video of a valve replacement, the surgeons actually mention this issue and discuss their awareness of the need for care. If you want to watch the video, you can do so at:
http://video.google.com/videoplay?docid=-6218906821548692571#

I found watching this video to be one of the most reassuring things I did before surgery. It is not difficult to watch and one can learn a good deal about the details of how one's new valve will be put in place. I expected it to be messy but one of the astonishing things is to see just how neatly everything is done. The surgeon providing part of the commentary is Dr Denton Cooley who is one of the foremost heart surgeons in developing modern practices in valve replacement.

Larry

 

[camgough]

I had valve-sparing aortic root replacement surgery, and I needed a pacemaker post-op. I am a 30 year old male, in good shape. Prior to surgery I had right bundle branch block. Where I had my surgery in Ottawa, Canada I believe it is standard for all patients to have the temporary pacing wires in place when sewn up. If a temporary pacemaer is needed then it is ready to go. I had a tough surgery, and as a result needed a permanent pacemaker. I had 2 different lung infections post-op, and when I got out of the ICU I was still on the temporary pacemaker. Everyday the the EP (pacemaker doctors) would come to my room and change the settings. I had full heart block. My surgeon wanted to give it a few extra days because he said the last person who had a pacemaker put in post op, got their own rythem back 2 days after the pacemaker surgery. I guess that as the heart heals and the swelling goes down, there is a chance the electronics can come back t normal, but mine did not. The pacemaker doctor's would not even discuss implanting the pacemaker until I had been off my 10 day cycle anti-biotics for 2 days. Exactly 3 weeks after my open heart surgery, I had my pacemaker put in. I have a Medtronics Adapta dual chamber. The surgery was not bad at all. I was awake and it took about an hour. That night, on bed rest, I ate pizza for the first time and had a Coke. The next day the EP doctor's checked my new, permanent pacemaker and said it was working well. I was also worried about have the temporary wires taken out, but it is not that bad! The best part of it was once that was done I got to go home! My shoulder area was sore for about a week or two when I got home, but it gets better with quickly. A week later I had my first real shower and a cold beer! At about 6 months post op I am pretty used to my pacemaker now. It has a low setting of 60bpm, and a high of 180bpm. When I get to 180bpm it "slows" my heart down. If you have any further questions, concerns please let me know. I have no idea what the % of people are that need post-op pacemakers, but from what I can remember it was not even mentioned to me by the surgeon before surgery. Thanks.

 

[Duff Man]

I don't think the graft has much if any to do with the need for a pacemaker just after surgery. I can't see the graft itself nicking the av bundle, or having much consequence to the bundle.