Division of Cardiology and Department of Internal Medicine, University of Louisville, 550 South Jackson Street 3rd Floor, Louisville, Kentucky, 40202 USA.
Department of Medicine, University of Tennessee, Coleman College of Medicine Bldg. 956 Court Ave., Suite A312 Memphis, TN 38163, USA.
Europace. 2017 Dec 1;19(12):1988-1993. doi: 10.1093/europace/euw391.
Permanent pacemaker placement (PPM) is often required after valvular surgery and is especially common following tricuspid valve surgery [tricuspid valve repair or replacement (TVR)]. Literature suggests that surgical intervention for isolated tricuspid valve disease is becoming more prevalent. Predictors of PPM dependency following TVR are currently unknown and would be clinically useful from a prognostication standpoint.
We conducted a multicentre, retrospective study to assess perioperative factors of TVR that predispose to PPM placement and long-term PPM dependency from 2008 to 2014. Regression analysis was used to determine independent predictors of PPM implantation. A total of 237 patients (age 66 ± 15 years, 29% male) were studied, and the incidence of PPM placement following TVR was 27% (65/237). No significant differences were observed between those who received PPM and those who did not in age (P = 0.092), gender (P = 0.359), and co-morbidities. Regression analysis identified cross-clamp time >60 min (OR 4.1, 95% CI 1.3-12.9, P = 0.015) and concomitant mitral valve surgery (OR 3.8, 95% CI 1.2-12.2, P = 0.026) as independent risk factors for PPM following TVR. Long-term PPM dependency data were only available in 28 patients who received PPM with 14 of these patients developing long-term dependence. The only statistically significant difference noted was an increased frequency of coronary artery disease in the long-term dependent group vs. the non-dependent group (64% vs. 14%, P = 0.018).
Cross-clamp time >60 min and concomitant mitral valve surgery were independent predictors of PPM implantation following TVR. Long-term PPM dependency is more prevalent after TVR than other types of valvular surgery.
瓣膜手术后常需安置永久性起搏器（PPM），尤其在三尖瓣手术后更为常见[三尖瓣修复或置换（TVR）]。文献表明，针对孤立性三尖瓣疾病的手术干预越来越常见。目前尚不清楚 TVR 后 PPM 依赖的预测因素，从预后角度来看，这些因素具有临床应用价值。
我们进行了一项多中心回顾性研究，以评估 2008 年至 2014 年间 TVR 围手术期因素与 PPM 放置及长期 PPM 依赖的相关性。回归分析用于确定 PPM 植入的独立预测因素。共纳入 237 例患者（年龄 66±15 岁，29%为男性），TVR 后 PPM 放置率为 27%（65/237）。接受 PPM 和未接受 PPM 的患者在年龄（P=0.092）、性别（P=0.359）和合并症方面无显著差异。回归分析发现，体外循环时间>60 分钟（OR 4.1，95%CI 1.3-12.9，P=0.015）和同期行二尖瓣手术（OR 3.8，95%CI 1.2-12.2，P=0.026）是 TVR 后 PPM 的独立危险因素。仅在接受 PPM 的 28 例患者中获得了长期 PPM 依赖数据，其中 14 例患者发展为长期依赖。唯一有统计学意义的差异是长期依赖组冠状动脉疾病的发生率高于非依赖组（64% vs. 14%，P=0.018）。
体外循环时间>60 分钟和同期行二尖瓣手术是 TVR 后 PPM 植入的独立预测因素。TVR 后 PPM 依赖比其他类型的瓣膜手术更为常见。
