Do transvalvular pacemaker leads influence functional outcome after tricuspid ring annuloplasty?

Area of Science:

• Cardiovascular Surgery
• Cardiac Electrophysiology
• Valvular Heart Disease

Background:

• The necessity of explanting transvalvular permanent pacemaker (PPM) leads during tricuspid valve (TV) repair for functional tricuspid regurgitation (TR) remains debated.
• This study investigates the impact of transvalvular PPM leads on the functional outcomes of TV repair.

Purpose of the Study:

• To evaluate the influence of transvalvular PPM leads on functional outcomes after TV repair.
• To assess the effect of PPM leads on TV-related reoperations and survival rates.
• To clarify the role of PPM leads in patients undergoing TV repair for functional TR.

Main Methods:

• Retrospective review of 415 patients undergoing TV ring annuloplasty between July 2007 and February 2013.
• Analysis of 112 patients (27%) with pre- or post-operative PPM implantation.
• 94% follow-up completion (mean 24.4 months, 845 patient-years).

Main Results:

• Preoperative moderate/severe TR (mean annulus 44.8 mm) improved significantly post-repair (TR grade 0.70 ± 0.54).
• Five-year freedom from recurrent TR was 86.7%, and from TV reoperations was 98.1%.
• Multivariate analysis confirmed transvalvular PPM presence was not a risk factor for recurrent TR, reoperations, or late mortality.

Conclusions:

• Transvalvular PPM leads do not adversely affect functional outcomes after TV ring annuloplasty for functional TR.
• The presence of PPM leads does not increase the risk of TV-related reoperations or late mortality.
• Explantation of transvalvular PPM leads may not be necessary at the time of TV repair.