Permanent Pacemaker Requirements after Tricuspid Valve Surgery—A Comprehensive Single Center Experience

Background: Recent data (CTSN trial) showed an increased requirement for permanent pacemaker (PPM) implantation (>10%) if tricuspid valve (TV) repair is performed concomitantly. However, external validation of these data is wanting. We analyzed the PPM requirements following TV procedures (TVP) during the first and 2nd half of the existence of our department. During the 2nd half, a standard operating procedure (SOP) for addressing the TV was introduced.

Methods: We analyzed data of all patients who underwent TVP in our center. Peri-operative follow-up was 100%. The SOP consisted of beating heart strategy (when applicable), removal and replacement of sutures near the triangle of Koch if signs of rhythm disorder were detected.

Results: Between 1999 and 2023, 1700 TVPs were performed in the absence of PPM preoperatively. Before the introduction of the SOP (12 years), 207 TVPs were performed (170 repairs). After SOP introduction (12.5 years) 1533 TVPs were performed (1406 repairs). Postoperative PPM requirements (incl. replacements) was 13.5% in the first half and 4.0% in the second half of the observation period. Among isolated TV repairs, new PPM were required in 13.3% in the first and 1.6% in the second period. Among mitral valve (MV) patients with concomitant tricuspid repair, new PPM were required in 17.1% in the first and 2.3% in the second period. The PPM incidence in the second half was not different from patients receiving MV surgery alone. After tricuspid valve replacement, overall PPM requirements was 21.6% in the first and 11% in the second half of the observation period.

		1999–2010 Patients with TVP		PPM	%	2011–2023 Patients with TVP	PPM %
Isolated TV	TV repl.		25	6	24.0%	86	9	10.5%
	TV repair		30	4	13.3%	182	3	1.6%
TV + MV	TV repl.		7	2	28.6%	23	2	8.7%
	TV repair		76	13	17.1%	657	15	2.3%
TV + other	TV repair		64	3	4.7%	567	30	5.3%
Total	TV repl.		37	8	21.6%	127	14	11.0%
	TV repair		170	20	11.8%	1,406	48	3.4%
Total			207	28	13.5%	1,533	62	4.0%

Conclusion: TV surgery can be performed with very low rates of PPM. The introduction of an SOP might reduce the need for PPM. Furthermore, there appears to be a relation to surgical experience.

 

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Artikel online veröffentlicht:
13. Februar 2024