Permanent Pacemaker Implantation After Subpulmonic and Systemic Tricuspid Valve Surgery in Adults with Congenital...

Adults with congenital heart disease (CHD) frequently undergo tricuspid valve surgery in either the subpulmonic or systemic tricuspid valve position. Surgical manipulation near the conduction system places these patients at risk for postoperative conduction disturbances requiring permanent pacemaker (PPM) implantation. However, perioperative factors associated with PPM implantation after tricuspid valve surgery in adults with CHD remain incompletely characterized. We performed a retrospective single-center cohort study of adults with CHD (age ≥ 18 years) undergoing tricuspid valve surgery between 2010 and 2021. Preoperative demographic and clinical characteristics, operative variables, and early postoperative outcomes were compared between patients requiring PPM implantation and those who did not. The primary endpoint was PPM implantation within 30 days of surgery. Thirty-four adults with CHD underwent tricuspid valve surgery, including 30 patients in the subpulmonic cohort with atrial situs solitus and 4 patients in the systemic cohort with congenitally corrected transposition of the great arteries. PPM implantation within 30 days occurred in 14 of 34 patients (41%): 12 of 30 (40%) in the subpulmonic cohort and 2 of 4 (50%) in the systemic cohort. Temporary epicardial pacing was more common among PPM recipients (83% vs. 39%). Postoperative bradyarrhythmias were more common among PPM recipients, with complete atrioventricular (AV) block accounting for most pacing indications. Many PPM recipients had undergone multiple prior sternotomies. PPM implantation following tricuspid valve surgery in adults with CHD occurs at substantially higher rates than previously reported congenital and non-congenital tricuspid surgery populations. Early postoperative conduction abnormalities were common and may identify patients at increased risk for persistent atrioventricular block.