Permanent Pacemaker Requirement after Tricuspid Valve Surgery

Objectives: Permanent pacemaker (PPM) requirement is a known complication of heart valve surgery. There is currently only little published data on PPM requirement after tricuspid valve surgery. The aim of this study was to identify the incidence and analyze risk factors for pacemaker requirement after tricuspid valve surgery.

Methods: Data from 505 patients undergoing tricuspid valve surgery (for regurgitation or stenosis of any etiology) between 2004 and 2017 was reviewed. Patients with pacemakers prior to surgery were excluded from the study. Among other statistical analyses, Kaplan Meier analysis was performed.

Results: After tricuspid valve surgery, 77 patients (15.2%) required a PPM. Pacemakers were implanted a median of 17 days after tricuspid valve surgery. They were most frequently required for atrioventricular block. Predictors for PPM requirement were preoperative endocarditis (p = 0.039) and “inadequate postoperative rhythm” at ICU admission (p = 0.001; defined as any rhythm with an intrinsic heart rate below 45/min). There was no difference in survival in patients with and those without pacemakers.

Conclusions: A relatively high amount of patients who have undergone tricuspid valve surgery later require permanent pacing (in our cohort 15.2%). Patients with preoperative active endocarditis and an “inadequate postoperative rhythm” at ICU admission had a higher risk for PPM requirement after surgery. Understanding the high incidence of this postoperative complication as well as the possible predictors can allow early decision-making regarding further care.

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