Simultaneous Tricuspid Valve Repair at the Time of Mitral Valve Surgery: Determinants of Postoperative Pacemaker Implantation

Fernando M Juarez-Casso; Hartzell V Schaff; Austin Todd; Arman Arghami; Phillip G Rowse; Joseph A Dearani; Richard C Daly; Nishant Saran; Juan A Crestanello

doi:10.1016/j.jtcvs.2024.05.018

Simultaneous Tricuspid Valve Repair at the Time of Mitral Valve Surgery: Determinants of Postoperative Pacemaker Implantation

J Thorac Cardiovasc Surg. 2024 May 27:S0022-5223(24)00449-5. doi: 10.1016/j.jtcvs.2024.05.018. Online ahead of print.

Authors

Fernando M Juarez-Casso¹, Hartzell V Schaff², Austin Todd³, Arman Arghami¹, Phillip G Rowse¹, Joseph A Dearani¹, Richard C Daly¹, Nishant Saran¹, Juan A Crestanello¹

Affiliations

¹ Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
² Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: schaff@mayo.edu.
³ Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 38810791
DOI: 10.1016/j.jtcvs.2024.05.018

Abstract

Objective: Guidelines recommend tricuspid valve (TV) repair for patients with severe tricuspid valve regurgitation (TR) undergoing surgery for degenerative mitral valve (MV) disease, but management of ≤ moderate TR is controversial. This study examines the incidence and causes of bradyarrhythmias leading to PPM implantation.

Methods: Review of patients undergoing simultaneous TV repair and MV surgery for degenerative MV disease from 2001 to 2022 (N=404). Primary endpoint was the incidence of postoperative PPM implantation. Secondary endpoints included the incidence of high-degree AV block and overall survival.

Results: All patients underwent TV repair at the time of MV surgery; 332 (82%) underwent MV repair and 72 (18%) MV replacement. Tricuspid valve repair techniques included flexible band (n=258, 63.8%), DeVega annuloplasty (n=78, 19.3%), complete flexible ring (n=49, 12.1%), and incomplete rigid ring (n=19, 4.7%). The 30-day mortality was 0.5% (n=2). A total of 35 (8.7%) patients had a PPM implanted postoperatively, 26 (6.4%) for high-degree AV block. On multivariable analysis, only older age was associated with PPM implantation. Patients who received a PPM due to high-degree AV block had reduced overall survival (Figure, p=0.01).

Conclusions: Need for permanent pacing following TV repair at the time of MV surgery is not uncommon, but there are few modifiable factors that might reduce this risk. Careful selection of patients with less-than-severe TR and surgical techniques may reduce PPM-related risks and complications.

Keywords: mitral valve regurgitation; pacemaker implantation; tricuspid valve repair.