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Ann Thorac Surg 2009;87:1806-1814. doi:10.1016/j.athoracsur.2009.03.048
© 2009 The Society of Thoracic Surgeons
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Janne J. Jokinen
Mikko J. Hippeläinen
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Right arrow Valve disease

Original Articles: Adult Cardiac

Pacemaker Therapy After Tricuspid Valve Operations: Implications on Mortality, Morbidity, and Quality of Life

Janne J. Jokinen, MDa,*, Anu K. Turpeinen, MD, PhDb, Otto Pitkänen, MD, PhDc, Mikko J. Hippeläinen, MD, PhDd, Juha E.K. Hartikainen, MD, PhDb

a Department of Cardiothoracic Surgery, Helsinki University Hospital, Helsinki, Finland
b Department of Medicine, Kuopio University Hospital, Kuopio, Finland
c Department of Anesthesiology, Kuopio University Hospital, Kuopio, Finland
d Department of Surgery, Kuopio University Hospital, Kuopio, Finland

Accepted for publication March 17, 2009.

* Address correspondence to Dr Jokinen, Department of Cardiothoracic Surgery, Helsinki University Hospital, PO Box 340, Helsinki, FI-00029, Finland (Email: janne.jokinen{at}helsinki.fi).

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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Ann. Thorac. Surg., June 1, 2009; 87(6): 1814 - 1815.
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