Simultaneous tricuspid valve repair at the time of mitral valve surgery: Determinants of postoperative pacemaker implantation.

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 or greater TR is controversial. This study examines the incidence and causes of bradyarrhythmia leading to permanent pacemaker (PPM) implantation.

Methods: We reviewed patients undergoing simultaneous TV repair and MV surgery for degenerative MV disease from 2001 to 2022 (N = 404). Primary end point was the incidence of postoperative PPM implantation. Secondary end points included the incidence of high-degree atrioventricular (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. TV 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 as the result of high-degree AV block had reduced overall survival (P = .01).

Conclusions: Need for permanent pacing after 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.