Permanent pacemaker implantation following mitral valve surgery: a retrospective cohort study of risk factors and long-term outcomes

2021 ◽  
Author(s):  
Mark R Helmers ◽  
Max Shin ◽  
Amit Iyengar ◽  
Gabriel R Arguelles ◽  
Jarvis Mays ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mitral Valve ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Permanent Pacemaker ◽  
Valve Surgery ◽  
Term Survival ◽  
Long Term Survival ◽  
Valvular Surgery

Abstract OBJECTIVES Conduction disturbances requiring permanent pacemaker (PPM) implantation remain a complication following valvular surgery. PPMs confer the risk of infection, tricuspid valve regurgitation and pacing-induced cardiomyopathy. Literature examining PPM placement in mitral valve surgery (MVS) is limited. METHODS Our institutional mitral valve (MV) database was retrospectively reviewed for adult patients undergoing surgery from 2011 to 2019. Patients with preoperative PPM were excluded. Patients were stratified by the receipt of PPM following their index operations. Multivariable logistic regression was performed to determine patient and operative risk factors for PPM. Subgroup analysis was performed on patients who underwent isolated MVS. Kaplan–Meier analysis and a multivariable Cox proportional hazards model were utilized to assess the association between PPM implantation and long-term survival. RESULTS A total of 3391 (2991 non-PPM and 400 PPM) patients met the study criteria. Significant predictors of PPM included increased decade of age (odds ratio: 1.23; 95% confidence interval: 1.12–1.35), concomitant aortic (1.44; 1.10–1.90) and tricuspid valve procedures (2.21; 1.64–2.97) and prior history of myocardial infarction (1.48; 1.07–1.86). In the isolated MV repair population, annuloplasty with ring prosthesis was associated with PPM (3.09; 1.19–8.02). Patients in the replacement population did not have significant identifiable risk factors. There was no survival difference found, and postoperative PPM placement was not found to be an independent predictor of mortality. CONCLUSIONS Our primary aim was to elucidate predictors for PPM implantation in MVS and found increasing age and concomitant procedures to be risk factors. Receipt of PPM is associated with worse long-term survival but does not independently predict survival. Among patients undergoing isolated MV repair, use of an annuloplasty ring confers a higher risk of PPM compared to an annuloplasty band.

scholarly journals De Vega annuloplasty versus ring annuloplasty for repair of functional tricuspid regurgitation

2018 ◽  
Vol 6 (2) ◽  
pp. 422
Author(s):  
Khaled Alnawaiseh ◽  
Bashar Albkhoor ◽  
Yanal Alnaser ◽  
Hayel Aladwan ◽  
Issa Ghanma
Keyword(s):  
Mitral Valve ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Term Survival ◽  
Free Survival ◽  
Ring Group ◽  
Ring Annuloplasty

Background: Tricuspid insufficiency (TI) is a functional insufficiency in most of the cases and associated with the dilatation of the annulus and remolding. Pulmonary hypertension and right ventricular volume overload due to chronic aortic or / and mitral valve disease in most of the time causes the functional tricuspid insufficiency. Despite the different techniques used to repair the tricuspid valve, the recurrent TR is still occurring in 20- 30 % of the patients and the development of late TR is an important complication of left heart surgery. Our study aims to compare the long-term outcome of ring annuloplasty with De Vega annnuloplasty in patients with secondary tricuspid regurgitation (TR).Methods: A retrospective study of 320 patients who underwent tricuspid valve repair surgery for secondary tricuspid regurgitation from January 2002 to December 2010 at Queen Alia Heart Institute (QAHI). Patients were divided into two groups, in group (1) (n=180) patients had an annuloplasty ring. Group (2) (n=140) patients had De Vega procedure (no ring). The procedures were performed in association with mitral valve surgery in 78% of patients, aortic valve surgery in 15% and combined aortic and mitral valve surgery in 7% of patients. TR grade, NYHA functional class and Pulmonary artery pressure were nearly similar and no significant preoperative difference between the two groups.Results: Echocardiographic and clinical follow up were done for all patients. The duration of procedure for both De Vega and ring annuloplasty were nearly similar. The overall survival in ring group at 5year was 83.9% versus 77.9% in De Vega group. Freedom from residual and recurrent TR, event free survival and long-term survival were significantly better in the ring group and also the tricuspid valve reoperation were less in the ring group.Conclusions: The implantation of annuloplasty ring results in lower incidence of residual or recurrent of tricuspid regurgitation, improved the event-free survival and long-term survival when compared with the sewing techniques such as De Vega.

Abstract 2305: Determinants of Outcomes Following Mitral Valve Surgery in Patients with Severe Organic Mitral Regurgitation and No or Mild Symptoms

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Julien Magne ◽  
Patrick Mathieu ◽  
François Dagenais ◽  
Eric Charbonneau ◽  
Jean G Dumesnil ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Long Term Survival ◽  
Long Term Mortality

The optimal timing of mitral valve surgery in patients with severe organic mitral regurgitation (OMR) and no or mild symptoms is highly controversial. The aim of this study was thus to determine the preoperative predictors of mortality following mitral valve surgery in patients with severe OMR and no or mild symptoms. Preoperative and operative data of 324 patients (65% of male, mean age: 65±13 years) with severe OMR and no/mild symptoms (NYHA class I and II) who underwent mitral valve surgery between 1992 and 2007 were prospectively collected in a computerized database. Mitral valve repair (MVRp) was performed in 132 (41%) and mitral valve replacement (MVR) in 187 (59%) patients. Operative mortality was low for both procedures (whole cohort: n=9, 2.7%; MVRp: n=2, 1.5%; MVR: n=7, 3.7%; p=0.34) but was significantly higher in the patients (n=167, 56%) with impaired preoperative left ventricular ejection fraction (LVEF) (<60%) (5.3% vs. 1.2%, p=0.04). Long-term survival was 93±2% at 5 years and 87±3% at 10 years. Patients with LVEF<60% had significantly reduced long-term survival compared to patients with normal LVEF (5-year: 89±4% vs. 95±5%, 10-year: 80±6% vs. 88±4%, p=0.049). Multivariate analysis identified age (Hazard-ratio [HR]= 1.03, 95% confidence interval (CI): 1–1.08, p=0.02), heart failure (HR= 1.9, 95%CI: 1.3–3, p= 0.0018), and LVEF (HR= 1.04, 95%CI: 1.01–1.07, p=0.0253) as independent predictors of long-term mortality. Furthermore, MVR was not associated with worse long-term survival on both univariate (p=0.83) and multivariate (p=0.98) analysis. Performing mitral valve surgery is safe in patients with severe OMR and no or mild symptoms. Impaired LVEF is associated with increased short- and long-term mortality, suggesting that these patients should be promptly operated before the onset of LV dysfunction.

scholarly journals Long-term outcomes of concomitant tricuspid valve repair in patients undergoing mitral valve surgery

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Ayse Cetinkaya ◽  
Natalia Ganchewa ◽  
Stefan Hein ◽  
Karin Bramlage ◽  
Peter Bramlage ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Long Term Outcomes
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