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The Journal of Cardiovascular Surgery 2021 Apr 08

DOI: 10.23736/S0021-9509.21.11803-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Mid-term results after isolated tricuspid valve surgery in the presence of right ventricular leads

Bettina PFANNMUELLER 1 , Luca-Marie BUDDE 1, Christian D. ETZ 1, Thilo NOACK 1, Mateo M. CUARTAS 1, Martin MISFELD 1, 2, 3, Michael A. BORGER 1

1 University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; 2 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australi; 3 The Discipline of Medicine, The Central Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia


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BACKGROUND: Patients with tricuspid valve (TV) disease and indication for TV surgery frequently have permanent pacemaker (PM) or defibrillator (AICD) leads, placed in the right ventricle (RV). The aim of this study was to analyse postoperative results and mid-term outcomes after isolated TV surgery (with no further concomitant cardiac procedures) in the presence of permanent RV leads.
METHODS: From January 2005 to January 2019 a total of 80 patients (mean age: 67.7±10.3 yrs; 56.3% male) with isolated TV disease and presence of at least one permanent RV lead in place were referred to our institution for isolated TV repair / replacement; patients with concomitant procedures were excluded for this analysis. All data were retrospectively analysed. The follow-up was 98% complete.
RESULTS: Mean follow-up time was 4.3±3.9 years. Mean preoperative clinical NYHA status was 3.0±0.8, left ventricular ejection fraction 50.7±12.9%, mean pulmonary artery pressure 23.8±9.3mmHg, creatinine 125.7±57.5μmol/l, mean MELD-XI Score (Model of Endstage-Liver Disease excluding INR) was 14.6±5.0 μmol/l. Thirty-day mortality was 6.3% with a 5-years survival of 58.2±6.0%. Cox regression analysis revealed the MELD-XIScore as the only highly significant predictor for postoperative mortality (p=0.002).
CONCLUSIONS: In conclusion, Hepatorenal dysfunction-possibly indicating long lasting TV failure- could be a factor for limited postoperative survival in our patient cohort. This finding could unterline our hypothesis, that early TV surgery may achieve better postoperative survival, even in patients with TV disease caused by RV leads. Further investigations are needed.


KEY WORDS: Tricuspid valve surgery; Pacemaker lead; MELD-XI

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