title: Transvalvular pacemaker leads increase the recurrence of regurgitation after tricuspid valve repair.
abstract: BACKGROUND
  The impact of a transvalvular pacemaker lead on the progression of tricuspid regurgitation (TR) after tricuspid valve (TV) repair has not been clearly demonstrated. The aim of this study was to evaluate the presence of a transvalvular pacemaker lead as a risk factor for TR after TV repair in a large patient cohort.
  
  
  METHODS
  A retrospective review included 791 patients who underwent TV repair at our institution from 1977 to 2008. All patients bearing a transvenous pacemaker implanted either preoperatively or within 30 days of surgery were categorized in the "PACE" group (n=176), the remaining patients were categorized in the "NO PACE" group (n=615).
  
  
  RESULTS
  Mean age was 61±11 years, and 575 patients (73%) were female. Mean follow-up was 5.8±5.5 years. Operative mortality was 13%. At discharge, TR severity was 3+ or greater in 10% and 15% of patients in the PACE and NO PACE groups, respectively (p=0.19). Multivariate analysis using a Cox regression model identified the presence of a transvenous pacemaker as an independent risk factor for recurrence of TR 2+ or greater (hazard ratio [HR] 1.60, p=0.008) and TR 3+ or greater (HR 1.47, p=0.046) at last follow-up. The presence of a transvenous pacemaker was also a significant independent predictor of late mortality (HR 2.12, p=0.02).
  
  
  CONCLUSIONS
  In patients undergoing tricuspid valve surgery, the presence of a transvenous pacemaker implanted either preoperatively or within 30 days of surgery is associated with a significantly increased risk of persistent or recurrent TR at late follow-up.
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Amine
authors.initials: A
authors.lastname: Mazine
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Moss
authors.forename: Guillaume
authors.initials: G
authors.lastname: Marquis-Gravel
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
authors.forename: Philippe
authors.initials: P
authors.lastname: Demers
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.forename: Raymond
authors.initials: R
authors.lastname: Cartier
authors.forename: Michel
authors.initials: M
authors.lastname: Pellerin
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014463:Ultrasonography
keywords: 24