Jérôme Jouan1, Alessandro Mele2, Emmanuelle Florens3, Gilles Chatellier4, Alain Carpentier3, Paul Achouh3, Jean-Noël Fabiani3. 1. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France. Electronic address: jouanjerome@hotmail.com. 2. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Paris, France. 3. Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département de Chirurgie Cardio-vasculaire, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France. 4. Université Paris-Descartes, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département d'Epidémiologie et de Recherche Clinique, Paris, France.
Abstract
OBJECTIVE: Tricuspid valve repair has been recently advocated in patients undergoing mitral valve surgery who have mild to moderate secondary tricuspid regurgitation. However, the incidence of heart conduction disorders after combined mitral valve and tricuspid valve interventions has not been evaluated. We sought to analyze the incidence of permanent pacemaker implantations and heart conduction disorders in patients undergoing mitral valve surgery with and without tricuspid valve annuloplasty. METHODS: In 2011 and 2012, among 201 consecutive patients referred to the Hôpital Européen Georges Pompidou for isolated nonischemic mitral valve disease, 113 underwent an isolated mitral valve procedure (group 1) and 88 had a concomitant tricuspid valve ring annuloplasty (group 2). RESULTS: Patients' mean age was 59.7 ± 16.5 years in group 1 and 60.7 ± 14.9 years in group 2 (P = .5). Mean crossclamp time and bypass time were 78 ± 35 minutes and 105 ± 47 minutes in group 1 and 92 ± 36 minutes and 128 ± 50 minutes in group 2, respectively (P = .001 and .005, respectively). Operative mortality was 3% (2.7% in group 1 and 3.2% in group 2, P = .4). Incidence of high-grade heart conduction disorders lasting more than 3 days postoperatively was 14.5% in group 1 and 41.2% in group 2 (P = .001). At 3 years, freedom from permanent pacemaker implantation was 99% ± 2% in group 1 and 94.1% ± 5% in group 2 (P = .02). For the entire cohort, longer crossclamp time (P = .02) and tricuspid ring annuloplasty (hazard ratio, 3.8; P = .001) were independent predictors of heart conduction disorders. CONCLUSIONS: The need for permanent pacemaker implantation is increased after concomitant tricuspid ring annuloplasty in the setting of mitral valve surgery. A clinical period of observation up to 14 days after postoperative heart conduction disorders should be observed before recommending permanent pacemaker placement.
OBJECTIVE: Tricuspid valve repair has been recently advocated in patients undergoing mitral valve surgery who have mild to moderate secondary tricuspid regurgitation. However, the incidence of heart conduction disorders after combined mitral valve and tricuspid valve interventions has not been evaluated. We sought to analyze the incidence of permanent pacemaker implantations and heart conduction disorders in patients undergoing mitral valve surgery with and without tricuspid valve annuloplasty. METHODS: In 2011 and 2012, among 201 consecutive patients referred to the Hôpital Européen Georges Pompidou for isolated nonischemic mitral valve disease, 113 underwent an isolated mitral valve procedure (group 1) and 88 had a concomitant tricuspid valve ring annuloplasty (group 2). RESULTS:Patients' mean age was 59.7 ± 16.5 years in group 1 and 60.7 ± 14.9 years in group 2 (P = .5). Mean crossclamp time and bypass time were 78 ± 35 minutes and 105 ± 47 minutes in group 1 and 92 ± 36 minutes and 128 ± 50 minutes in group 2, respectively (P = .001 and .005, respectively). Operative mortality was 3% (2.7% in group 1 and 3.2% in group 2, P = .4). Incidence of high-grade heart conduction disorders lasting more than 3 days postoperatively was 14.5% in group 1 and 41.2% in group 2 (P = .001). At 3 years, freedom from permanent pacemaker implantation was 99% ± 2% in group 1 and 94.1% ± 5% in group 2 (P = .02). For the entire cohort, longer crossclamp time (P = .02) and tricuspid ring annuloplasty (hazard ratio, 3.8; P = .001) were independent predictors of heart conduction disorders. CONCLUSIONS: The need for permanent pacemaker implantation is increased after concomitant tricuspid ring annuloplasty in the setting of mitral valve surgery. A clinical period of observation up to 14 days after postoperative heart conduction disorders should be observed before recommending permanent pacemaker placement.
Authors: James S Gammie; Michael W A Chu; Volkmar Falk; Jessica R Overbey; Alan J Moskowitz; Marc Gillinov; Michael J Mack; Pierre Voisine; Markus Krane; Babatunde Yerokun; Michael E Bowdish; Lenard Conradi; Steven F Bolling; Marissa A Miller; Wendy C Taddei-Peters; Neal O Jeffries; Michael K Parides; Richard Weisel; Mariell Jessup; Eric A Rose; John C Mullen; Samantha Raymond; Ellen G Moquete; Karen O'Sullivan; Mary E Marks; Alexander Iribarne; Friedhelm Beyersdorf; Michael A Borger; Arnar Geirsson; Emilia Bagiella; Judy Hung; Annetine C Gelijns; Patrick T O'Gara; Gorav Ailawadi Journal: N Engl J Med Date: 2021-11-13 Impact factor: 91.245
Authors: Jae Woong Choi; Kyung Hwan Kim; Su Chan Lim; Sue Hyun Kim; Suk Ho Sohn; Yeiwon Lee; Ho Young Hwang Journal: Korean J Thorac Cardiovasc Surg Date: 2020-12-05