Pacemaker implantation associated with tricuspid repair in the setting of mitral valve surgery: Insights from a Cardiothoracic Surgical Trials Network randomized trial.
Pacemaker implantation associated with tricuspid repair in the setting of mitral valve surgery: Insights from a Cardiothoracic Surgical Trials Network randomized trial.
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二尖瓣手术中起搏器植入与三尖瓣修复相关：来自心胸外科试验网络随机试验的见解。
DOI：
10.1016/j.jtcvs.2022.11.031
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
M
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作者：
Ailawadi,Gorav;Voisine,Pierre;Raymond,Samantha;Gelijns,AnnetineC;Moskowitz,AlanJ;Falk,Volkmar;Overbey,JessicaR;Chu,MichaelWA;Mack,MichaelJ;Bowdish,MichaelE;Krane,Markus;Yerokun,Babatunde;Conradi,Lenard;Bolling,StevenF;M
目标在最近的一项试验中，在治疗退行性二尖瓣反流的二尖瓣手术 (MVS) 期间进行三尖瓣环成形术 (TA) 和中度或轻度三尖瓣反流 (TR) 降低了 2 年死亡率、TR 再次手术或 TR 进展的复合率。然而，这种好处被永久起搏器（PPM）植入的增加所抵消。在这项研究中，我们分析了这些植入的时机、适应症和风险因素。方法我们对 401 名患者进行了随机分组（仅 MVS = 203；MVS + TA = 198）。使用多变量事件发生时间模型评估 PPM 的潜在风险因素，其中死亡和心力衰竭适应症植入 PPM 作为竞争风险。结果 随机分组后 2 年内，36 名患者 (9.6; 95% CI, 6.8-13.0) 植入了 PPM，其中 30/187 (16.0%) 为 MVS + TA，6/188 (3.2%) MVS 组（比率，5.08；95% CI，2.16-11.94；P<0.001）。大多数（29/36；80.6%）植入发生在术后 30 天内。 2 年内 PPM 植入的独立危险因素包括 TA（风险比 [HR]，5.94；95% CI，2.27-15.53；P<0.001）、年龄增加（5 岁，HR，1.23；95% CI，1.01-1.52；P=0.04）和左心室射血分数（LVEF；HR， 0.96；95% CI，0.92-0.99；P=.02)。在 TA 接受者子集中 (n = 197)，年龄（5 岁，HR，1.05；95% CI，1.00-1.10；P= .04）和 LVEF（HR，0.95；95% CI，0.91-0.99；P= .01）在 2 年内与 PPM 相关。年龄和基线 LVEF 是因退行性二尖瓣反流而接受 MVS 的患者植入 PPM 的危险因素。尽管 TA 可有效预防 TR 进展，但仍需要创新来找到降低 PPM 植入率的方法。
ObjectivesIn a recent trial, tricuspid annuloplasty (TA) during mitral valve surgery (MVS) for degenerative mitral regurgitation and moderate or less tricuspid regurgitation (TR) reduced the composite rate of death, reoperation for TR, or TR progression at 2 years. However, this benefit was counterbalanced by an increase in implantation of permanent pacemakers (PPMs). In this study, we analyzed the timing, indications, and risk factors for these implantations.MethodsWe randomized 401 patients (MVS alone = 203; MVS + TA = 198). Potential risk factors for PPMs were assessed using multivariable time-to-event models with death and PPM implantation for heart failure indications as competing risks.ResultsA PPM was implanted in 36 patients (9.6; 95% CI, 6.8-13.0) within 2 years of randomization, with 30/187 (16.0%) in the MVS + TA and 6/188 (3.2%) in the MVS groups (rate ratio, 5.08; 95% CI, 2.16-11.94;P< .001). Most (29/36; 80.6%) implantations occurred within 30 days postoperatively. Independent risk factors for PPM implantation within 2 years were TA (hazard ratio [HR], 5.94; 95% CI, 2.27-15.53;P< .001), increasing age (5 years, HR, 1.23; 95% CI, 1.01-1.52;P= .04), and left ventricular ejection fraction (LVEF; HR, 0.96; 95% CI, 0.92-0.99;P= .02). In the subset of TA recipients (n = 197), age (5 years, HR, 1.05; 95% CI, 1.00-1.10;P= .04) and LVEF (HR, 0.95; 95% CI, 0.91-0.99;P= .01) were associated with PPM within 2 years.ConclusionsConcomitant TA, age, and baseline LVEF were risk factors for PPM implantation in patients who underwent MVS for degenerative mitral regurgitation. Although TA was effective in preventing progression of TR, innovation is needed to identify ways to decrease PPM implantation rates.