Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery
Background Data regarding permanent pacemaker (PPM) implantation following tricuspid valve surgery (TVS) are limited. We sought to evaluate its incidence, risk factors, and outcomes. Methods and Results Medicare beneficiaries who underwent TVS from 2013 to 2020 were identified. Patients who underwen...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-02-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.032760 |
| _version_ | 1797296253729505280 |
|---|---|
| author | Joseph Kassab Serge C. Harb Milind Y. Desai A. Marc Gillinov Habib Layoun Joseph El Dahdah Michel Chedid El Helou Shady Nakhla Haytham Elgharably Samir R. Kapadia Paul C. Cremer Amgad Mentias |
| author_facet | Joseph Kassab Serge C. Harb Milind Y. Desai A. Marc Gillinov Habib Layoun Joseph El Dahdah Michel Chedid El Helou Shady Nakhla Haytham Elgharably Samir R. Kapadia Paul C. Cremer Amgad Mentias |
| author_sort | Joseph Kassab |
| collection | DOAJ |
| description | Background Data regarding permanent pacemaker (PPM) implantation following tricuspid valve surgery (TVS) are limited. We sought to evaluate its incidence, risk factors, and outcomes. Methods and Results Medicare beneficiaries who underwent TVS from 2013 to 2020 were identified. Patients who underwent TVS for endocarditis were excluded. The primary exposure of interest was new PPM after TVS. Outcomes included all‐cause mortality and readmission with endocarditis or heart failure on follow‐up. Among the 13 294 patients who underwent TVS, 2518 (18.9%) required PPM placement. Risk factors included female sex (relative risk [RR], 1.26 [95% CI, 1.17–1.36], P<0.0001), prior sternotomy (RR, 1.12 [95% CI, 1.02–1.23], P=0.02), preoperative second‐degree heart block (RR, 2.20 [95% CI, 1.81–2.69], P<0.0001), right bundle‐branch block (RR, 1.21 [95% CI, 1.03–1.41], P=0.019), bifascicular block (RR, 1.43 [95% CI, 1.06–1.93], P=0.02), and prior malignancy (RR, 1.23 [95% CI, 1.01–1.49], P=0.04). Tricuspid valve (TV) replacement was associated with a significantly higher risk of PPM implantation when compared with TV repair (RR, 3.20 [95% CI, 2.16–4.75], P<0.0001). After a median follow‐up of 3.1 years, mortality was not different in patients who received PPM compared with patients who did not (hazard ratio [HR], 1.02 [95% CI, 0.93–1.12], P=0.7). PPM placement was not associated with a higher risk of endocarditis but was associated with a higher risk of heart failure readmission (HR, 1.28 [95% CI, 1.14–1.43], P<0.001). Conclusions PPM implantation frequently occurs after TVS, notably in female patients and patients undergoing TV replacement. Although mortality is not increased, it is associated with higher rates of heart failure rehospitalization. |
| first_indexed | 2024-03-07T22:01:54Z |
| format | Article |
| id | doaj.art-213651eded3a43b1a3a4e5ae6e2b2578 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T22:01:54Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-213651eded3a43b1a3a4e5ae6e2b25782024-02-24T04:06:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-02-0113310.1161/JAHA.123.032760Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve SurgeryJoseph Kassab0Serge C. Harb1Milind Y. Desai2A. Marc Gillinov3Habib Layoun4Joseph El Dahdah5Michel Chedid El Helou6Shady Nakhla7Haytham Elgharably8Samir R. Kapadia9Paul C. Cremer10Amgad Mentias11Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USADepartment of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USADepartment of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USADepartment of Cardiovascular Surgery Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USADepartment of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USADepartment of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USADepartment of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USADepartment of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USADepartment of Cardiovascular Surgery Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USADepartment of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USADepartment of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USADepartment of Cardiovascular Medicine Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USABackground Data regarding permanent pacemaker (PPM) implantation following tricuspid valve surgery (TVS) are limited. We sought to evaluate its incidence, risk factors, and outcomes. Methods and Results Medicare beneficiaries who underwent TVS from 2013 to 2020 were identified. Patients who underwent TVS for endocarditis were excluded. The primary exposure of interest was new PPM after TVS. Outcomes included all‐cause mortality and readmission with endocarditis or heart failure on follow‐up. Among the 13 294 patients who underwent TVS, 2518 (18.9%) required PPM placement. Risk factors included female sex (relative risk [RR], 1.26 [95% CI, 1.17–1.36], P<0.0001), prior sternotomy (RR, 1.12 [95% CI, 1.02–1.23], P=0.02), preoperative second‐degree heart block (RR, 2.20 [95% CI, 1.81–2.69], P<0.0001), right bundle‐branch block (RR, 1.21 [95% CI, 1.03–1.41], P=0.019), bifascicular block (RR, 1.43 [95% CI, 1.06–1.93], P=0.02), and prior malignancy (RR, 1.23 [95% CI, 1.01–1.49], P=0.04). Tricuspid valve (TV) replacement was associated with a significantly higher risk of PPM implantation when compared with TV repair (RR, 3.20 [95% CI, 2.16–4.75], P<0.0001). After a median follow‐up of 3.1 years, mortality was not different in patients who received PPM compared with patients who did not (hazard ratio [HR], 1.02 [95% CI, 0.93–1.12], P=0.7). PPM placement was not associated with a higher risk of endocarditis but was associated with a higher risk of heart failure readmission (HR, 1.28 [95% CI, 1.14–1.43], P<0.001). Conclusions PPM implantation frequently occurs after TVS, notably in female patients and patients undergoing TV replacement. Although mortality is not increased, it is associated with higher rates of heart failure rehospitalization.https://www.ahajournals.org/doi/10.1161/JAHA.123.032760all‐cause mortalityheart failureincidencepermanent pacemakerrisk factortricuspid valve surgery |
| spellingShingle | Joseph Kassab Serge C. Harb Milind Y. Desai A. Marc Gillinov Habib Layoun Joseph El Dahdah Michel Chedid El Helou Shady Nakhla Haytham Elgharably Samir R. Kapadia Paul C. Cremer Amgad Mentias Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease all‐cause mortality heart failure incidence permanent pacemaker risk factor tricuspid valve surgery |
| title | Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery |
| title_full | Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery |
| title_fullStr | Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery |
| title_full_unstemmed | Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery |
| title_short | Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery |
| title_sort | incidence risk factors and outcomes associated with permanent pacemaker implantation following tricuspid valve surgery |
| topic | all‐cause mortality heart failure incidence permanent pacemaker risk factor tricuspid valve surgery |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.032760 |
| work_keys_str_mv | AT josephkassab incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery AT sergecharb incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery AT milindydesai incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery AT amarcgillinov incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery AT habiblayoun incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery AT josepheldahdah incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery AT michelchedidelhelou incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery AT shadynakhla incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery AT haythamelgharably incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery AT samirrkapadia incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery AT paulccremer incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery AT amgadmentias incidenceriskfactorsandoutcomesassociatedwithpermanentpacemakerimplantationfollowingtricuspidvalvesurgery |