Factors Associated With Permanent Pacemaker Placement After Tricuspid Valve Operations

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.