Factors Associated With Permanent Pacemaker Placement After Tricuspid Valve Operations

Salman Zaheer; Sari D Holmes; Emily Rodriguez; Nolan M Winicki; Emily Larson; Rachael Quinn; Gorav Ailawadi; A Marc Gillinov; James S Gammie

doi:10.1016/j.athoracsur.2024.09.042

Factors Associated With Permanent Pacemaker Placement After Tricuspid Valve Operations

Ann Thorac Surg. 2024 Oct 18:S0003-4975(24)00862-2. doi: 10.1016/j.athoracsur.2024.09.042. Online ahead of print.

Authors

Salman Zaheer¹, Sari D Holmes², Emily Rodriguez², Nolan M Winicki², Emily Larson², Rachael Quinn², Gorav Ailawadi³, A Marc Gillinov⁴, James S Gammie²

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: szaheer4@jhmi.edu.
² Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ University of Michigan School of Medicine, Ann Arbor, Michigan.
⁴ Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

PMID: 39426556
DOI: 10.1016/j.athoracsur.2024.09.042

Abstract

Background: Conduction abnormalities requiring permanent pacemaker (PPM) implantation are common after tricuspid valve operations, although the incidence is variable. This study investigated contemporary rates of and risk factors for a PPM after tricuspid operations.

Methods: The Society of Thoracic Surgeons Adult Cardiac Surgery Database was used to identify patients with tricuspid repair or replacement from 2011 to 2020. Factors independently associated with the risk of a postoperative PPM during the index hospital admission were examined using multivariable logistic regression with a complete case approach. Annualized hospital and surgeon volumes were calculated.

Results: We identified 71,937 patients undergoing tricuspid operations. Median patient age was 66 years (interquartile range, 53-74 years), 56% (n = 40,590) were women, and the median ejection fraction was 0.56 (interquartile range, 0.48-0.60). Tricuspid operations were concomitant in 87% (n = 62,457), elective in 62% (n = 44,393), and included repair in 86% (n = 61,720). Overall postoperative incidence of a PPM was 15% (n = 10,857); 13% (n = 8304) after repair and 25% (n = 2553) after replacement; and 4% (n = 174) for isolated tricuspid repair and 24% (n = 1248) for isolated tricuspid replacement. Multivariable analysis showed baseline characteristics, endocarditis, concomitant operations, longer cardiopulmonary bypass time, tricuspid replacement, and lower hospital and surgeon tricuspid operative volumes were independently associated with greater risk for a PPM. After adjustment, tricuspid replacement had 3.2-times greater PPM risk compared with tricuspid repair.

Conclusions: Nationally, 15% of patients undergoing tricuspid operations required postoperative PPM implantation. PPM risk was increased with concomitant valve operations, tricuspid replacement, longer cardiopulmonary bypass time, and operations performed by less experienced surgeons and centers. Innovation is needed to decrease this significant morbidity.