Pacemaker Implantation After Tricuspid Valve Surgery at a High-Volume Regional Reference Center

Background: The rate of permanent pacemaker implantation after tricuspid valve (TV) operation is thought to be high, with some studies quoting rates of 20% to 30%. We identified the rate of pacemaker implantation after TV operation at a high-volume regional reference center to better characterize the contemporary risk of pacemaker. Methods: All adult patients without preexisting pacemakers undergoing TV operation from 2011 to 2022 were included. Patients were categorized by type of tricuspid operation and concomitant procedures. Bivariable analysis and multivariable logistic and Cox regression were performed to compare outcomes and to identify covariates independently associated with pacemaker implantation and long-term mortality. Results: A total of 1346 patients with no history of pacemaker underwent TV operation. The overall rate of pacemaker was 11% (142/1346), with a 9.2% (113/1235) pacemaker rate with TV repair vs 26% (29/111) rate with TV replacement (P < .001). For isolated TV operations, permanent pacemaker rate was 3.7% (5/135) for repairs vs 23% (18/79) for replacement (P < .001). Need for pacemaker implantation varied significantly by type of operation. Adjusting for patient and operative characteristics, combined aortic root and valve operation, combined mitral and tricuspid surgery, longer cross-clamp time, and tricuspid replacement were independent risk factors for pacemaker. There was no difference in long-term mortality between the groups. Conclusions: In this large data series, the rate of pacemaker with any TV operation was 11% and ranged from 0% to 33% according to concomitant procedures. Contemporary risk of pacemaker after TV operation at a high-volume center may be lower than previously thought.