title: Perioperative predictors of permanent pacing and long-term dependence following tricuspid valve surgery: a multicentre analysis.
abstract: OBJECTIVE
  Permanent pacemaker placement (PPM) is often required after valvular surgery and is especially common following tricuspid valve surgery [tricuspid valve repair or replacement (TVR)]. Literature suggests that surgical intervention for isolated tricuspid valve disease is becoming more prevalent. Predictors of PPM dependency following TVR are currently unknown and would be clinically useful from a prognostication standpoint.
  
  
  RESULTS
  We conducted a multicentre, retrospective study to assess perioperative factors of TVR that predispose to PPM placement and long-term PPM dependency from 2008 to 2014. Regression analysis was used to determine independent predictors of PPM implantation. A total of 237 patients (age 66 ± 15 years, 29% male) were studied, and the incidence of PPM placement following TVR was 27% (65/237). No significant differences were observed between those who received PPM and those who did not in age (P = 0.092), gender (P = 0.359), and co-morbidities. Regression analysis identified cross-clamp time >60 min (OR 4.1, 95% CI 1.3-12.9, P = 0.015) and concomitant mitral valve surgery (OR 3.8, 95% CI 1.2-12.2, P = 0.026) as independent risk factors for PPM following TVR. Long-term PPM dependency data were only available in 28 patients who received PPM with 14 of these patients developing long-term dependence. The only statistically significant difference noted was an increased frequency of coronary artery disease in the long-term dependent group vs. the non-dependent group (64% vs. 14%, P = 0.018).
  
  
  CONCLUSIONS
  Cross-clamp time >60 min and concomitant mitral valve surgery were independent predictors of PPM implantation following TVR. Long-term PPM dependency is more prevalent after TVR than other types of valvular surgery.
authors.affiliation: Division of Cardiology and Department of Internal Medicine, University of Louisville, 550 South Jackson Street 3rd Floor, Louisville, Kentucky, 40202 USA.
authors.forename: Philip L
authors.initials: PL
authors.lastname: Mar
authors.affiliation: Division of Cardiology and Department of Internal Medicine, University of Louisville, 550 South Jackson Street 3rd Floor, Louisville, Kentucky, 40202 USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Angus
authors.affiliation: Department of Medicine, University of Tennessee, Coleman College of Medicine Bldg. 956 Court Ave., Suite A312 Memphis, TN 38163, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kabra
authors.affiliation: Division of Cardiology and Department of Internal Medicine, University of Louisville, 550 South Jackson Street 3rd Floor, Louisville, Kentucky, 40202 USA.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Migliore
authors.affiliation: Department of Medicine, University of Tennessee, Coleman College of Medicine Bldg. 956 Court Ave., Suite A312 Memphis, TN 38163, USA.
authors.forename: Rohan
authors.initials: R
authors.lastname: Goswami
authors.affiliation: Department of Medicine, University of Tennessee, Coleman College of Medicine Bldg. 956 Court Ave., Suite A312 Memphis, TN 38163, USA.
authors.forename: Leah A
authors.initials: LA
authors.lastname: John
authors.affiliation: Division of Cardiology and Department of Internal Medicine, University of Louisville, 550 South Jackson Street 3rd Floor, Louisville, Kentucky, 40202 USA.
authors.forename: Yixi
authors.initials: Y
authors.lastname: Tu
authors.affiliation: Division of Cardiology and Department of Internal Medicine, University of Louisville, 550 South Jackson Street 3rd Floor, Louisville, Kentucky, 40202 USA.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gopinathannair
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D003250:Constriction; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D007629:Kentucky; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D013714:Tennessee; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*
keywords: Atrioventricular block; Bradycardia; Pacemaker dependency; Permanent pacemaker; Tricuspid valve surgery; Valve repair