Key result
Preoperative active endocarditis predicts a ~217% increase in early pacemaker requirement after tricuspid valve surgery.
Why the study?
The incidence and predictors of pacemaker requirement after tricuspid valve surgery were not well quantified.
Cohort (n=505)
Preoperative active endocarditis and initial postoperative bradycardia are strong predictors of the high requirement for pacemaker implantation following tricuspid valve surgery.
Answers are grounded in this paper and cite their sources.
May guide closer postoperative monitoring in endocarditis patients after tricuspid valve surgery; hypothesis-generating and requires prospective validation.
AIMS: The tricuspid valve is situated in close proximity to cardiac conduction tissue and damage to this tissue can affect postoperative rhythm. The aim of this study was to quantify the incidence of pacemaker requirement after tricuspid valve surgery and investigate predictors. METHODS: Data were collected via our operative data collection system and patient files. All patients who underwent surgical procedures of the tricuspid valve from 2004 until 2017 and lacked a pacemaker preoperatively were included in the study. RESULTS: In our cohort of 505 patients 54 required a pacemaker in the first 50 days after surgery. We calculated a 17.5% (95% confidence interval [CI], 13.5-21.3) risk of pacemaker implantation at 4 years postoperatively. Multivariate analysis identified preoperative active endocarditis (odds ratio 3.17; CI, 1.32-7.65; P = 0.010) and "inadequate pacemaker dependent rhythm" (defined as any intrinsic heart rate below 45 per minute requiring pacing) upon admission to the intensive care unit after surgery (odds ratio 5.924; CI, 2.82-12.44; P = 0.001) as predictors for pacemaker requirement in the first 50 days after surgery. Twenty-six pacemakers (48%) were implanted for atrioventricular block, 16 (30%) for sinus node dysfunction and 12 (22%) for atrial fibrillation. Kaplan-Meier analysis showed no difference in survival between the pacemaker and no pacemaker group. CONCLUSION: Surgery of the tricuspid valve has a high burden of postoperative pacemaker requirement. Preoperative active endocarditis and the initial postoperative rhythm are predictors. Understanding this allows for better decision-making regarding further medical/device therapy.
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Herrmann et al. (2019) conducted a cohort in Tricuspid valve disease (n=505). Preoperative active endocarditis vs. No preoperative active endocarditis was evaluated on Pacemaker requirement in the first 50 days after surgery (OR 3.17, 95% CI 1.32-7.65, p=0.010). Preoperative active endocarditis (OR 3.17; 95% CI 1.32-7.65) and inadequate postoperative rhythm were significant predictors of pacemaker requirement within 50 days of tricuspid valve surgery.
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