Effect of Tricuspid Repair on Pacemaker Rate After Mitral Repair Is Higher in Degenerative Disease

Permanent pacemaker (PPM) placement after mitral valve (MV) repair is affected by concomitant procedures, yet existing literature reports conflicting rates. We aimed to characterize the effect of concomitant operation on risk of need for postoperative PPM in patients who underwent MV repair.

A retrospective review of a prospectively maintained institutional database (1996-2020) was conducted of consecutive patients undergoing MV repair, including concomitant procedures. Multivariable regression analysis was performed to evaluate the effect of a concomitant procedure on PPM rate.

Of the 2824 patients undergoing MV repair, 6% (177/2824) required a PPM. The likelihood of PPM varied with concomitant procedures: aortic valve replacement (39/258 [15%]), coronary artery bypass grafting (86/789 [11%]), tricuspid valve (TV) repair (33/326 [10%]), and maze (27/407 [7%]). Increased PPM rate was associated with aortic valve replacement (odds ratio [OR], 2.2 [1.5-3.3]; P < .001), reduced ejection fraction (OR, 1.02 [1.01-1.04]; P < .001), and older age (OR, 1.04 [1.03-1.06]; P < .001). Concurrent TV repair was not associated with pacemaker in patients undergoing MV repair (P = .8) or MV repair for nondegenerative mitral regurgitation (P = .9). In patients with degenerative MV disease, PPM rate increased from 1.9% (21/1133) to 10% (11/109) with concomitant TV repair (P < .001), and TV repair was associated with a 3-fold increased pacemaker rate (OR, 3.1 [1.6-5.9]; P < .001).

In MV repair, risk of pacemaker with concomitant TV repair should be weighed more heavily in degenerative MV disease. Pacemaker risk should not discourage surgeons from performing TV repair in patients with nondegenerative MV disease, in patients already undergoing concomitant operation or with clinically significant tricuspid regurgitation.