Cohort study
Permanent Pacemaker Implantation and Long-Term Outcomes of Patients Undergoing Concomitant Mitral and Tricuspid Valve Surgery
- Retrospective cohort study
- propensity-score weighted
- 90-day conditional landmark analysis
- New York and California state discharge databases
Authors' conclusion
Compared to isolated MVr, adding TA to MVr was associated with a higher risk of 90-day PPM implantation. In both surgical groups, PPM implantation was associated with an increase in mortality, HFH, and endocarditis.
Study context
- Population
- Patients undergoing isolated mitral valve repair (MVr) or MVr with concomitant tricuspid annuloplasty (TA), New York and California, 2004–2019isolated MVr 28,003
- Participants
- 32,736 patients
- Exposure
- Permanent pacemaker (PPM) vs no PPM within 90 days after MVr or MVr + TA
- Outcome
- Incidence of PPM implantation after isolated MVr and MVr + TA, and long-term consequences of PPM (survival, HF hospitalization, endocarditis, stroke, reoperation)
- Follow-up
- <90 days after surgery (PPM)
Main finding
As reported in the abstract
PPM implantation <90 days and long-term survival
PPM vs No PPMHazard ratio (95% CI)P value
reduced long-term survival, MVr
1.96(1.75–2.19)
P < 0.001reduced long-term survival, MVr + TA
1.65(1.28–2.14)
P < 0.001Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| HF hospitalization (both surgical groups) | 1.56 (1.27–1.90) | P < 0.001 | |
| Endocarditis (both surgical groups) | 1.95 (1.52–2.51) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
Stroke, reoperation
- PPM not associated with stroke or reoperation
Temporal trends
- Annual MVr + TA volumes increased
- P < 0.001, trend
- PPM rates decreased
- P < 0.001, trend
Original publication
Permanent Pacemaker Implantation and Long-Term Outcomes of Patients Undergoing Concomitant Mitral and Tricuspid Valve Surgery. J Am Coll Cardiol. Published 30 April 2024. doi:10.1016/j.jacc.2024.02.042
Summarised from the published abstract; every number is checked against it