• Bettina Pfannmueller, Gregor Hirnle, Joerg Seeburger, Piroze Davierwala, Thomas Schroeter, Michael Andrew Borger, and Friedrich Wilhelm Mohr.
• University of Leipzig - Heart Center, Clinic for Cardiac Surgery, Leipzig, Germany. pfab@med.uni-leipzig.de
• Eur J Cardiothorac Surg. 2011 May 1; 39 (5): 657-61.

ObjectiveFew studies have focussed on the outcomes of tricuspid valve (TV) repair in patients with a right ventricular permanent pacemaker lead (PPL) and tricuspid regurgitation (TR).MethodsRetrospective analysis of all patients with a PPL undergoing TV repair (annuloplasty ring in 83 patients and De Vega annuloplasty in 33 patients) between April 2001 and May 2008 (n=116) was performed. The mean patient age was 71 ± 8.8 years; 59.8% were female, and the average European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 16.4 ± 14.5%. Follow-up was 100% complete with a mean duration of 19.4 ± 20.3 months.ResultsIn addition to annular dilatation, leaflet injury secondary to PPL was observed in eight patients (7%). Isolated ring implantation or De Vega annuloplasty was performed in all patients, including five of the eight patients with leaflet injury. In the remaining three patients, the PPL was removed and an epicardial lead was implanted. A 30-day mortality was 14.6% and a 5-year survival 45% (95% confidence interval (CI): 29.4-61.6%). Four patients underwent TV re-operation resulting in a 5-year freedom of 93.4% from TV-related re-operation (95% CI: 88.2-97.7). Two of the four re-operated patients had PPL-related leaflet injury at the time of the initial operation and the PPL was left in situ.ConclusionsPatients with a pre-existing PPL, who require TV surgery for significant TR, however without evidence of PPL-induced TR, can undergo TV repair without removal of the PPL. In patients with evidence of PPL-related TR, we suggest PPL removal followed by insertion of an epicardal or transcoronary sinus lead.Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

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