MP44. Permanent Pacemaker Implantation After Tricuspid Valve Repair Surgery
Presented During: Moderated E-Posters
Yale
New Haven, CT
United States - Contact Me
Alyssa Morrison is a fourth-year medical student at Yale School of Medicine where she is completing a research year under the mentorship of Arnar Geirsson, MD in cardiac surgery focused on surgical outcomes.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Objective: Recent studies suggest that permanent pacemaker (PPM) implantation after concomitant tricuspid valve repair (TVr) and mitral valve surgery is higher than previously thought. Our aim was to assess permanent pacemaker implantation (PPI) rate and risk factors after isolated and concomitant tricuspid valve repair surgery.
Methods: We performed a retrospective analysis of all TVr at a single tertiary academic center performed from 2014-2022. Patients with pre-existing PPM or implantable cardiac defibrillators (ICD) and those with implantation during index procedure were excluded. Survival was assessed using Kaplan-Meier survival analysis.
Results: Tricuspid valve repair was performed in 231 patients, with isolated TVr in 22. Concomitant procedures included mitral valve (MV) repair (81), MV replacement (109), aortic valve replacement (AVR) (41), coronary artery bypass grafting (30), and Maze procedure (57).
Within 30 days of TVr, 23/231 (9.96%) of patients underwent PPI. PPI occurred at median 6 days (IQR 5-7) with a range of 2-14. The indications for the 23 PPM were atrioventricular (AV) node block in 16/23 and sinoatrial (SA) node dysfunction in 6/23. There was no significant difference between the rates of Maze procedure amongst patients with early PPI (9/29) vs without (48/208), P=.123.
In assessing differences between patients with early PPI and those without early PPI, there were no significant differences between the groups regarding baseline demographic characteristics or comorbidities such as age, sex, history of myocardial infarction, and history of prior cardiac surgery (Table 1). There were also no differences in operative characteristics such as rates of concomitant procedures such as AVR or MV surgery, or in annuloplasty/valve size.
Median follow-up was 2.76 years (IQR 1.18-4.78). Late PPI occured in 15 patients, median 1.23 years (IQR 0.64-4.6) after TVr. Indications for late PPI include AV node dysfunction (4), SA node dysfunction (10), and unknown (1). There was no significant difference in the long-term survival based on early PPI status (P=0.305).
Conclusions: The rate of PPM implantation following TVr within 30 days postoperatively in our cohort was 9.96%, suggesting PPM implantation is not an uncommon occurrence in the perioperative period for tricuspid valve repair surgery, and typically occurs within the first 10 days. AV block accounts for the majority of early PPI, followed by SA node dysfunction.
Methods: We performed a retrospective analysis of all TVr at a single tertiary academic center performed from 2014-2022. Patients with pre-existing PPM or implantable cardiac defibrillators (ICD) and those with implantation during index procedure were excluded. Survival was assessed using Kaplan-Meier survival analysis.
Results: Tricuspid valve repair was performed in 231 patients, with isolated TVr in 22. Concomitant procedures included mitral valve (MV) repair (81), MV replacement (109), aortic valve replacement (AVR) (41), coronary artery bypass grafting (30), and Maze procedure (57).
Within 30 days of TVr, 23/231 (9.96%) of patients underwent PPI. PPI occurred at median 6 days (IQR 5-7) with a range of 2-14. The indications for the 23 PPM were atrioventricular (AV) node block in 16/23 and sinoatrial (SA) node dysfunction in 6/23. There was no significant difference between the rates of Maze procedure amongst patients with early PPI (9/29) vs without (48/208), P=.123.
In assessing differences between patients with early PPI and those without early PPI, there were no significant differences between the groups regarding baseline demographic characteristics or comorbidities such as age, sex, history of myocardial infarction, and history of prior cardiac surgery (Table 1). There were also no differences in operative characteristics such as rates of concomitant procedures such as AVR or MV surgery, or in annuloplasty/valve size.
Median follow-up was 2.76 years (IQR 1.18-4.78). Late PPI occured in 15 patients, median 1.23 years (IQR 0.64-4.6) after TVr. Indications for late PPI include AV node dysfunction (4), SA node dysfunction (10), and unknown (1). There was no significant difference in the long-term survival based on early PPI status (P=0.305).
Conclusions: The rate of PPM implantation following TVr within 30 days postoperatively in our cohort was 9.96%, suggesting PPM implantation is not an uncommon occurrence in the perioperative period for tricuspid valve repair surgery, and typically occurs within the first 10 days. AV block accounts for the majority of early PPI, followed by SA node dysfunction.