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  • Title: Pacemaker therapy after tricuspid valve operations: implications on mortality, morbidity, and quality of life.
    Author: Jokinen JJ, Turpeinen AK, Pitkänen O, Hippeläinen MJ, Hartikainen JE.
    Journal: Ann Thorac Surg; 2009 Jun; 87(6):1806-14. PubMed ID: 19463599.
    Abstract:
    BACKGROUND: We studied the incidence and predictors of permanent pacemaker implantation after tricuspid valve operation and its implications on patient outcome in terms of survival, morbidity, and quality of life. METHODS: Between 1992 and 2007, 136 consecutive patients underwent tricuspid valve repair or valve replacement with a biologic valve at Kuopio University Hospital. Comprehensive clinical data were recorded prospectively. Data for the Nottingham Health Profile quality of life analysis were collected cross-sectionally. RESULTS: The mean follow-up time was 7.9 +/- 4.1 years (range, 0.8 to 15.7 years). A pacemaker was implanted in 28 patients (21%); 54% were implanted before hospital discharge. The 10-year survival of patients with a pacemaker was higher (94%) than of patients without a pacemaker (59%; p = 0.050). The need of a pacemaker was related to a significantly higher rate of transient ischemic attacks (30% vs 6%, p = 0.004), strokes (9% vs 4%; p = 0.008), and impaired physical capacity in terms of higher New York Heart Association functional class (p = 0.03) and the quality of life scores describing energy (31 vs 17; p = 0.01) and mobility (32 vs 17; p = 0.005). CONCLUSIONS: The need for pacemaker implantation after tricuspid valve operations was high. Unexpectedly, the life expectancy of the patients who needed a pacemaker postoperatively was higher compared with those who did not. This beneficial effect on mortality was offset by impaired morbidity: patients with a pacemaker experienced a significantly higher rate of thromboembolic complications and impaired quality of life.
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