Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries.

Background: The presence of permanent pacemakers (PPM) is common among the elderly population. Trauma literature has shown that the inability to augment cardiac output by at least 30% after injury portends a higher mortality. The presence of a PPM may be a surrogate marker to identify patients who are unable to increase cardiac output. We aimed to evaluate the association between the presence of PPM and clinical outcomes in elderly patients presenting with traumatic injuries. Methods: A total of 4505 patients aged ≥65 years admitted with acute trauma from 2009 to 2019 at our Level I Trauma center were evaluated and stratified into two groups using propensity matching on age, sex, injury severity score (ISS), and year of admission based on the presence of PPM. Logistic regression was performed to analyze the impact of the presence of PPM on mortality, surgical intensive care unit (SICU) admission, operative intervention, and length of stay. Prevalence of cardiovascular comorbidities was compared using χ2 analysis. Results: Data from 208 patients with PPM and 208 propensity-matched controls were evaluated. Charlson Comorbidity Index, mechanism of injury, intensive care unit admission, and rate of operative intervention were comparable in the two groups. PPM patients had more coronary artery disease (p=0.04), heart failure with reduced ejection fraction (p=0.003), atrial fibrillation (AF, p<0.0001), and antithrombotic use (p<0.0001). We found no association between mortality amongst the groups after controlling for influencing variables (OR=2.1 (0.97 to 4.74), p=0.061). Patient characteristics associated with survival included female sex (p=0.009), lower ISS (p<0.0001), lower revised trauma score (p<0.0001), and lower SICU admission (p=0.001). Conclusion: Our study shows no association between mortality among patients with PPM admitted for treatment of trauma. Presence of a PPM may be an indicator of cardiovascular disease, but this does not translate into increased risk in the modern era of trauma management in our patient population. Level of evidence: Level III.

Unruptured Multiple Sinus of Valsalva Aneurysms.

Sinus of Valsalva aneurysm (SVA) is a rare cardiac condition occurring in about 0.09% of the general population, with potential for grave complications. Unruptured sinus of Valsalva aneurysms of all three sinuses in the same patient are even more rare. There are congenital, inherited, or acquired causes. Noninvasive cross-sectional imaging modalities, consisting of color Doppler echocardiography, cardiac computed tomographic angiography (CCTA), and cardiac magnetic resonance imaging (MRI), make the diagnosis. Treatment is mainly by open surgical reconstruction. However, transcatheter techniques are gaining popularity with noninferior outcomes in selected cases. We report the diagnosis and successful management of a patient with an unusual presentation of multiple unruptured SVAs of all three sinuses, and we conducted a review of the English medical literature.