Pacemaker Implantation After Tricuspid Valve Surgery at a High-Volume Regional Reference Center

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Device Implantation

Background:

• Permanent pacemaker implantation rates after tricuspid valve (TV) operations are often cited as high (20-30%).
• Contemporary data on pacemaker implantation risk following TV surgery is limited.
• This study aimed to define the current risk of pacemaker implantation after TV operations.

Purpose of the Study:

• To determine the incidence of permanent pacemaker implantation after tricuspid valve surgery.
• To identify risk factors associated with pacemaker implantation following TV operations.
• To compare pacemaker implantation rates based on the type of tricuspid valve procedure.

Main Methods:

• Retrospective analysis of adult patients undergoing TV operations between 2011 and 2022.
• Categorization of patients based on tricuspid operation type and concomitant procedures.
• Statistical analysis including bivariable and multivariable logistic/Cox regression.

Main Results:

• Overall pacemaker implantation rate was 11% (142/1346) in patients without prior pacemakers.
• Tricuspid valve replacement had a significantly higher pacemaker rate (26%) compared to TV repair (9.2%).
• Independent risk factors included combined aortic root/valve surgery, combined mitral/tricuspid surgery, longer cross-clamp time, and tricuspid replacement.

Conclusions:

• The contemporary risk of pacemaker implantation after TV surgery at a high-volume center is 11%, potentially lower than previously estimated.
• Pacemaker need varies significantly based on the type of tricuspid valve operation and associated procedures.
• No significant difference in long-term mortality was observed between patients who received pacemakers and those who did not.