Permanent Pacemaker Implantation and Long-Term Outcomes of Patients Undergoing Concomitant Mitral and Tricuspid Valve Surgery

This study assessed the incidence rates of permanent pacemaker implantation (PPM) and the associated long-term clinical consequences of PPM implantation after isolated mitral valve (MV) repair compared to concomitant MV repair and tricuspid annuloplasty. Data from public hospital discharge databases from New York and California were queried for patients undergoing MV repair (isolated or with concomitant tricuspid annuloplasty) between 2004 and 2019. Patients were stratified by whether they received a PPM within 90 days of index surgery. After propensity score matching, survival, heart failure hospitalizations, endocarditis, stroke, and reoperation were compared between patients with or without PPM. A total of 32,736 patients underwent isolated MV repair (n = 28,003) or MV repair with tricuspid annuloplasty (n = 4,733). The incidence of PPM implantation less than 90 days after surgery was 7.7 percent for MV repair and 14.0 percent for MV repair with tricuspid annuloplasty. PPM was associated with reduced long-term survival among MV repair patients (HR: 1.96; 95 percent CI: 1.75-2.19; P < 0.001) and MV repair with tricuspid annuloplasty patients (HR: 1.65; 95 percent CI: 1.28-2.14; P < 0.001). In both surgical groups, PPM was also associated with an increased risk of heart failure hospitalizations (HR: 1.56; 95 percent CI: 1.27-1.90; P < 0.001) and endocarditis (HR: 1.95; 95 percent CI: 1.52-2.51; P < 0.001), but not with stroke or reoperation.