AI Article Synopsis

  • - This study reviews patients who had tricuspid valve (TV) repair during surgery for degenerative mitral valve (MV) disease, focusing on the need for permanent pacemaker (PPM) implantation after the procedure across 404 cases from 2001 to 2022.
  • - The findings revealed that 8.7% of patients required PPM implantation post-surgery, primarily due to high-degree AV block, with older age identified as a significant risk factor for this complication.
  • - The conclusions suggest that while PPM needs are relatively common after TV repair during MV surgery, careful patient selection and surgical techniques might help to lower the associated risks and improve patient outcomes.

Article 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.

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Source
http://dx.doi.org/10.1016/j.jtcvs.2024.05.018DOI Listing

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