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Risk of Pacemaker Implantation After Degenerative Mitral and Concomitant Tricuspid Valve Surgery
Alexander A Brescia1, Catherine M Wagner1, Danika E Meldrum1
1Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
The Annals of Thoracic Surgery
|May 27, 2024
Summary
Tricuspid annuloplasty during mitral surgery is safe, showing no increased mortality and a low permanent pacemaker rate. These findings offer real-world data for this combined procedure in degenerative mitral regurgitation.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Valvular Heart Disease
Background:
- A multicenter trial indicated tricuspid regurgitation (TR) progression reduction with tricuspid annuloplasty during degenerative mitral regurgitation (MR) surgery.
- However, this trial reported a significant 14% permanent pacemaker (PPM) rate.
Purpose of the Study:
- To evaluate real-world outcomes of degenerative MR surgery with and without concomitant tricuspid annuloplasty.
- To compare the safety and efficacy of these procedures at a high-volume center.
Main Methods:
- Retrospective analysis of 1738 patients undergoing first-time degenerative mitral surgery (2011-2021).
- Patients were stratified into mitral surgery alone (n=1068) versus mitral surgery plus tricuspid annuloplasty (n=417).
- Outcomes assessed included operative mortality, new PPM implantation, length of stay, and risk-adjusted overall mortality.
Main Results:
- Concomitant tricuspid annuloplasty was associated with a higher incidence of new PPM implantation (5.5% vs 0.7%, P < .001).
- Despite unadjusted lower survival in the tricuspid group, risk-adjusted analysis showed no significant difference in overall mortality (HR, 0.80; 95% CI, 0.53-1.19).
- Operative mortality was low at 1.4% across both groups.
Conclusions:
- Concomitant tricuspid annuloplasty is a safe procedure in high-volume mitral centers.
- The study demonstrates no increased mortality and a PPM rate below 6% for combined procedures.
- These real-world data support the use of concomitant tricuspid annuloplasty in select patients undergoing degenerative MR surgery.
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