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Factors Associated With Permanent Pacemaker Placement After Tricuspid Valve Operations.

Salman Zaheer1, Sari D Holmes1, Emily Rodriguez1

  • 1Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

The Annals of Thoracic Surgery
|October 19, 2024
PubMed
Summary
This summary is machine-generated.

Permanent pacemaker (PPM) implantation is needed in 15% of patients after tricuspid valve surgery. Tricuspid replacement and less experienced surgeons increase PPM risk, highlighting the need for improved surgical techniques.

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Electrophysiology

Background:

  • Conduction abnormalities requiring permanent pacemaker (PPM) implantation are common after tricuspid valve operations, with variable incidence.
  • Contemporary rates and risk factors for PPM after tricuspid operations require investigation.

Purpose of the Study:

  • To investigate contemporary rates of permanent pacemaker (PPM) implantation after tricuspid valve operations.
  • To identify risk factors associated with PPM implantation post-tricuspid surgery.

Main Methods:

  • Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2011-2020).
  • Inclusion of patients undergoing tricuspid repair or replacement.
  • Multivariable logistic regression to examine factors associated with postoperative PPM risk.

Main Results:

  • 15% of 71,937 patients required PPM implantation post-tricuspid operation.
  • Tricuspid replacement (3.2x higher risk vs. repair), concomitant operations, longer bypass times, and lower surgeon/hospital volumes increased PPM risk.
  • Isolated tricuspid repair had a 4% PPM rate, while isolated replacement had a 24% rate.

Conclusions:

  • Nationally, 15% of patients undergoing tricuspid operations require PPM implantation.
  • Increased PPM risk is linked to concomitant procedures, tricuspid replacement, longer cardiopulmonary bypass, and less experienced surgeons/centers.
  • Innovation is necessary to reduce this significant morbidity.