Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Sarwat Chaudhry

Second Advisor

Arnar Geirrson

Abstract

Recent studies suggest that permanent pacemaker implantation after tricuspid valve repair may be more common than previously thought. Our primary aim was to assess the rates of early (within 30 days of surgery) and late (more than 30 days after surgery) permanent pacemaker implantation (PPI) after tricuspid valve repair (TVr) surgery. Our secondary aims included exploring risk factors for PPI after TVr and assessing outcomes.

We performed a retrospective analysis of 231 isolated and concomitant tricuspid valve repairs for primary and secondary tricuspid valve regurgitation at a single quaternary academic center performed from 2014–2022.

Early pacemaker implantation was performed in 10.0% of patients (n=23) at median 6 (interquartile range [IQR], 5–7) days after surgery, with a range of 2–14 days. In assessing differences between patients with early pacemaker implantation and those without, there were no significant differences between the groups regarding baseline demographic characteristics, comorbidities, or operative characteristics. The indications for the pacemakers were atrioventricular node block in 69.6% and sinoatrial node dysfunction in 30.4%. Median follow-up was 2.8 (IQR, 1.2–4.8) years. Late pacemaker implantation, more than 30 days after surgery, occurred in 15 patients (7.2%), median 1.2 (IQR, 0.6–4.6) years after tricuspid valve repair. Although these analyses were under-powered, we found that the patient and surgical factors we evaluated, including history of atrial fibrillation and MAZE procedure, were not significant predictors of PPI. There was no significant difference in the long-term survival based on early pacemaker implantation status (unadjusted hazard ratio 0.54, 95% CI 0.22–1.37, P=0.305) or late pacemaker implantation (unadjusted hazard ratio 0.79, 95% CI 0.19-2.18, P=0.695).

The rate of permanent pacemaker implantation following tricuspid valve repair within 30 days postoperatively in our cohort was 10.0%, suggesting pacemaker implantation is not an uncommon occurrence in the perioperative period, and typically occurs within the first 10 days. Atrioventricular block accounts for the majority of early pacemakers (69.6%), followed by sinoatrial node dysfunction (30.4%).

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This is an Open Access Thesis.

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