Complication rates of cardiac implantable electronic device implantation in cardiac surgery patients
I Ragnvaldsson, A Taha, A Jeppsson, A David, J G Smith, A MartinssonAbstract
Background
Cardiac surgery is performed in patients with a large comorbid burden and high age, which increases the need for postoperative cardiac implantable electronic device (CIED) implantation and subsequently, complications related to CIED implantation.
Purpose
We hypothesized that type of cardiac surgery may influence the complication rates of CIED implantation and may consequently affect long term clinical outcomes. Therefore, this study aimed to systematically evaluate complication rates and procedure duration associated with CIED implantation in patients with prior cardiac surgery.
Methods
The study included all patients who underwent cardiac surgery due to coronary artery and/or valvular disease in Sweden between January 2006 and December 2020. Adjusted logistic and Cox regression analyses were used to evaluate the risk of complications and subsequent long-term outcomes after complications. The study population was derived from The Swedish Cardiac Surgery Registry, part of the SWEDEHEART registry. Comorbidities were identified in Sweden's National Patient Register. CIED procedures and complications were identified via the Swedish ICD and Pacemaker Registry. Any CIED procedure were included. Complications include arrhythmia requiring medication, perforation/tamponade, pneumothorax, hemothorax, venous embolism/thrombosis, stroke, local bleeding, pericardial fluid, infection, electrical dysfunction, lead dislodgement, and death.
Results
A total of 75,073 patients were included in the cardiac surgery cohort, of these 7,510 (10,0%) required a CIED at any point after surgery. The overall risk of complications following device implantation among cardiac surgery patients was 5.5%, at any point during a mean follow-up of 6.7 years. The most common complication was lead dislodgement which occurred in 2.0% of patients, Figure 1. There was no difference between the risk of device complication for valvular surgery or combined coronary/valve surgery compared to coronary artery bypass grafting. However, arrhythmia surgery was associated with an increased risk of device-related complications (odds ratio [OR] 1.67 [95% confidence interval 1.02-2.67], p=0.036). Procedural duration demonstrated a nonlinear association with complication risk, with increased risk at both shorter and longer procedure times. Implant procedure complications were associated with the primary combined outcome of heart failure and/or cardiovascular mortality (adjusted hazard ratio 1.27 [95% CI 1.05-1.54], p=0.016), in patients who had a pacemaker implanted.
Conclusion
Implantation of a cardiac implantable electronic device is common after cardiac surgery during long-term follow-up. Arrhythmia surgery conferred an increased risk of device-related complications. Furthermore, complications related to device implantation were independently associated with a higher risk of subsequent long-term adverse outcomes in patients who underwent CIED implantation.Complications by device type