Pacemaker implantation after concomitant tricuspid valve repair in patients undergoing minimally invasive mitral valve surgery: Results from the Mini-Mitral International RegistryCentral MessagePerspective
Gloria Faerber, MD, PhD,
Paolo Berretta, MD, PhD,
Tom C. Nguyen, MD, PhD,
Manuel Wilbring, MD, PhD,
Joseph Lamelas, MD, PhD,
Pierluigi Stefano, MD, PhD,
Jörg Kempfert, MD, PhD,
Mauro Rinaldi, MD, PhD,
Davide Pacini, MD, PhD,
Antonios Pitsis, MD, PhD,
Marc Gerdisch, MD, PhD,
Nguyen Hoang Dinh, MD, PhD,
Frank Van Praet, MD, PhD,
Loris Salvador, MD, PhD,
Tristan Yan, MD, PhD,
Nikolaos Bonaros, MD, PhD,
Antonio Fiore, MD, PhD,
Torsten Doenst, MD, PhD,
Marco Di Eusanio, MD, PhD
Affiliations
Gloria Faerber, MD, PhD
Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
Paolo Berretta, MD, PhD
Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
Tom C. Nguyen, MD, PhD
Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Tex
Manuel Wilbring, MD, PhD
Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
Joseph Lamelas, MD, PhD
Division of Cardiothoracic Surgery, University of Miami, Miami, Fla
Pierluigi Stefano, MD, PhD
Cardiac Surgery Unit, Careggi University Hospital, Firenze, Italy
Jörg Kempfert, MD, PhD
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
Mauro Rinaldi, MD, PhD
Cardiac Surgery Unit, University of Turin, Turin, Italy
Davide Pacini, MD, PhD
Cardiac Surgery Department, Sant’Orsola Malpighi Hospital, University of Bologna, Italy
Antonios Pitsis, MD, PhD
Cardiac Surgery Department, European Interbalkan Medical Center, Thessaloniki, Greece
Marc Gerdisch, MD, PhD
Franciscan Health Indianapolis, Indianapolis, Ind
Nguyen Hoang Dinh, MD, PhD
University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
Frank Van Praet, MD, PhD
Cardiac Surgery Department, Hartcentrum OLV Aalst, Aalst, Belgium
Loris Salvador, MD, PhD
Division of Cardiac Surgery, S. Bortolo Hospital, Vicenza, Italy
Tristan Yan, MD, PhD
Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
Nikolaos Bonaros, MD, PhD
Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
Antonio Fiore, MD, PhD
Henri Mondor Hospital, University of Paris, Paris, France
Torsten Doenst, MD, PhD
Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany; Address for reprints: Torsten Doenst, MD, PhD, Department of Cardiothoracic Surgery, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany.
Marco Di Eusanio, MD, PhD
Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
Objective: Randomized evidence suggests a high risk of pacemaker implantation for patients undergoing mitral valve (MV) surgery with concomitant tricuspid valve repair (cTVR). We investigated the impact of cTVR on outcomes in the Mini-Mitral International Registry. Methods: From 2015 to 2021, 7513 patients underwent minimally invasive MV with or without cTVR in 17 international centers (MV: n = 5609, cTVR: n = 1113). Propensity matching generated 1110 well-balanced pairs. Multivariable analysis was applied. Results: Patients with cTVR were older and had more comorbidities. Propensity matching eliminated most differences except for more TR in patients who underwent cTVR (77.2% vs 22.1% MV, P < .001). Mean matched age was 71 years, and 45% were male. European System for Cardiac Operative Risk Evaluation II was still 2.68% (interquartile range [IQR], 0.80-2.63) vs 1.9% (IQR, 1.12-3.9) in matched MV (P < .001). MV replacement (30%) and atrial fibrillation surgery (32%) were similar in both groups. Cardiopulmonary bypass (161 minutes [IQR, 133-203] vs MV: 130 minutes [IQR, 103-166]; P < .001) and crossclamp times (93 minutes [IQR, 66-123] vs MV: 83 minutes [IQR, 64-107]; P < .001) were longer with cTVR. Although in-hospital mortality was similar (cTVR: 3.3% vs MV: 2.2%; P = .5), postoperative pacemaker implantations (9% vs MV: 5.8%; P = .02), low cardiac output syndrome (7.7% vs MV: 4.4%; P = .02), and acute kidney injury (13.8% vs MV: 10%; P = .01) were more frequent with cTVR. cTVR eliminated relevant TR in most patients (greater-than-moderate TR: 6.8%). Multivariable analysis identified MV replacement, atrial fibrillation, and cTVR as risk factors of postoperative pacemaker implantation. Conclusions: cTVR in minimally invasive MV surgery is an independent risk factor for pacemaker implantation in this international registry. It is also associated with more bleeding, low output syndrome, and acute kidney injury. It remains unclear whether technical or patient factors (or both) explain these differences.
