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Incidence and Risk Factors for Permanent Pacemaker Implantation After Tricuspid Valve Repair.

Jae Woong Choi1,2, Muath Bishawi1, Carmelo Milano1

  • 1Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Annals of Thoracic Surgery Short Reports
|March 18, 2025
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Summary

Permanent pacemaker (PPM) implantation after tricuspid valve (TV) repair occurs in 10.3% of patients, with older age and prior radiation as risk factors. Importantly, PPM implantation does not negatively impact long-term outcomes.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Devices

Background:

  • The incidence and predictors of permanent pacemaker (PPM) implantation following tricuspid valve (TV) repair are not well-established.
  • Existing data suggest a potentially low likelihood compared to TV replacement, but this remains controversial.

Purpose of the Study:

  • To determine the incidence of PPM implantation after TV repair.
  • To identify risk factors associated with PPM implantation in this patient cohort.

Main Methods:

  • A retrospective review of 1058 patients who underwent TV repair between 1997 and 2019 was conducted.
  • Data were extracted from a prospectively maintained database.

Main Results:

  • The incidence of PPM implantation was 10.3%, with heart block being the most common indication.
  • Older age, prior mediastinal radiation, and concomitant mitral and aortic valve replacement were identified as risk factors.
  • Concomitant left ventricular assist device implantation was found to be a protective factor.

Conclusions:

  • PPM implantation after TV repair is more common than previously assumed.
  • Despite the need for PPM, early and long-term clinical outcomes, including survival and TV function, remain unaffected.
  • Risk stratification for PPM should consider patient age, prior radiation, and concurrent procedures.