Abstract 14369: Presence of a Transvalvular Pacemaker Increases the Risk of Postoperative Regurgitation Following Tricuspid Valve Surgery
Background: The impact of a transvalvular pacemaker lead on the progression of tricuspid regurgitation (TR) following tricuspid valve (TV) surgery has not been clearly demonstrated. The aim of this study was to evaluate the presence of a transvalvular pacemaker lead as a risk factor for TR following TV surgery in a large patient cohort.
Methods: A retrospective review included 926 patients who underwent TV surgery at our institution (792 repairs and 134 replacements) from 1977 to 2008. All patients bearing a transvenous pacemaker at last follow-up, were categorized in the “pacemaker” group (n=247), the remaining patients were categorized in the “no pacemaker” group (n=679).
Results: Median age was 62 years (inter-quartile range (IQR): 53 - 69 years), and 667 patients (72.1%) were female. Median follow-up was 4.3 years (IQR: 1.3 to 9.1 years). Preoperative tricuspid regurgitation (TR) severity was ≥ 3+ in 580 patients (62.5%). TR was secondary in 70.8% of cases and operative mortality was 13.8%. At last follow-up, 247 patients (26.7%) had a pacemaker. Among them, 114 had been implanted preoperatively, 14 peri-operatively, and 119 postoperatively. Multivariate logistic regression analysis identified the presence of a transvenous pacemaker as an independent risk factor for TR ≥ + (41.5% vs 20.2%, OR = 3.26; p = 0.0001), and for TR ≥ 2+ at last follow-up (65.7% vs 36.1%, OR = 4.38; p = 0.0001). Other risk factors for TR included gender, previous mitral valve surgery, and severity of TR immediately postoperatively.
Conclusion: In patients undergoing tricuspid valve surgery, the presence of a transvenous pacemaker, regardless of the time of implantation, is associated with a significantly increased risk of persistent or recurrent TR at late followup.
- © 2012 by American Heart Association, Inc.