Rezan Aksoy1, Emre Selçuk2, Ayhan Küp3, Deniz Çevirme1, Üzeyir Yılmaz1, Veysel Başar1, Furkan Balcı1, Murat Bülent Rabuş1

1Department of Cardiovascular Surgery, Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
2Department of Cardiovascular Surgery, Faculty of Medicine, University of Bezmialem Vakif, Istanbul, Turkey
3Department of Cardiology, Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey

Keywords: Mitral valve replacement; tricuspid annuloplasty; permanent pacemaker implantation


Introduction: This study compared the frequency of permanent pacemaker implantation (PPI) following mitral valve replacement (MVR) with tricuspid annuloplasty (TAP) and isolated MVR.

Patients and Methods: This retrospective study analysed 409 patients who had undergone MVR with or without concomitant TAP, from January 2015 through May 2020. Patients were divided into two groups (the isolated MVR group and the MVR plus TAP group). The two groups were compared according to whether PPI was present or not.

Results: A total of 409 consecutive patients [in the isolated MVR group, n= 212 patients; 129 (60.8%) female and in the MVR plus TAP group, n= 197 patients; 138 (70.1%) female] were assessed. The number of female, functional mitral regurgitation, mixed mitral disease, and the use of bio-prosthetic valve was higher in the MVR plus TAP group (p< 0.01). A total of 8 (2%) patients needed a PPI. There was no statistically significant difference between the two groups in terms of PPI (p> 0.01). The frequency of postoperative PPI was 2.2% (7 of 311 patients) in patients with rheumatic etiology and 1.1% (1 of 98 patients) in patients with non-rheumatic etiology (OR: 2.026, 95% CI: 0.24-16.68, p= 0.5). The median time to implantation was seven days [minimum postoperative days (POD) 5 , maximum POD 45].

Conclusion: When isolated MVR is considered and if the patient also has tricuspid regurgitation (TR), it is apparent that TAP will be inevitable, because TR inflicts a considerable burden on the patient’s quality of life. Recent studies reported varying frequencies of PPI after TAP accompanying left valve surgery. The present study observed no increase in the use of PPI after MVR accompanied by TAP as compared with isolated MVR.

Cite this article as: Aksoy R, Selçuk E, Küp A, Çevirme D, Yılmaz Ü, Başar V, et al. Does concomitant tricuspid annuloplasty increase the need for permanent pacemaker implantation following mitral valve replacement? Koşuyolu Heart J 2021;24(1):8-14.

Ethics Committee Approval

This study was approved by Kartal Kosuyolu High Specialization Training and Research Hospital, Clinic of Cardiovascular Surgery Ethics Committee (2020/8/358).

Author Contributions

Concept/Design - RA, DÇ; Analysis/Interpretation - ES, VB; Data Collection - AK, ÜY, FB; Writing - RA, ES; Critical Revision - MR; Final Approval - RA; Statistical Analysis - ES; Overall Responsibility - RA, MR.

Conflict of Interest

The authors have no conflicts of interest to declare

Financial Disclosure

The authors declared that this study has received no financial support.