Key result
Implantation of a Micra transcatheter pacing system under direct visualization during minimally invasive tricuspid valve surgery on a beating heart was safe and feasible, with stable pacing parameters.
Why the study?
AV block is common after tricuspid valve surgery, but transvenous pacing leads can cause mechanical interference with leaflet mobility and coaptation, leading to regurgitation.
Case Report (n=1)
No
Insertion of a leadless pacemaker under direct visualization during minimally invasive tricuspid valve surgery is safe and feasible, offering an alternative to epicardial or transvalvular leads in patients at high risk for complete heart block.
Answers are grounded in this paper and cite their sources.
May support leadless pacing as alternative during tricuspid surgery; hypothesis-generating, needs prospective validation before practice change.
Atrioventricular nodal conduction abnormalities are common after open heart surgery and more so during or after valve surgery. The incidence of atrioventricular (AV) block after tricuspid valve (TV) surgery is higher than what is observed following coronary artery bypass surgery or left sided valve interventions due to the proximity of the TV annulus to the AV node and hence requirements for cardiac pacing are high. However, the mechanical interference between pacing leads and TV leaflet mobility and coaptation can result in regurgitation rendering such an approach counterintuitive. We report a case of Micra Transcatheter pacing system (TPS) implant under direct visualization at the time of tricuspid valve surgery performed via a right mini-thoracotomy approach.
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Mohamad Sinno (2020) conducted a case report in Severe tricuspid valve regurgitation and intermittent complete heart block (n=1). Micra Transcatheter Pacing System implant under direct visualization was evaluated on Successful implantation and device performance. Implantation of a Micra transcatheter pacing system under direct visualization during minimally invasive tricuspid valve surgery on a beating heart was safe and feasible, with stable pacing parameters.
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