Abstract 17823: Impact of the Type of Tricuspid Annuloplasty Ring Concomitant With Mitral Annuloplasty on Atrial Arrhythmia Behaviour and Pacemaker Implantation Rate, Fact or Fancy

Abstract

Background: Tricuspid valve repair has been advocated in patients undergoing mitral valve surgery who have not only preoperative severe TR but also for tricuspid annular dilatation (TAD) of >40 mm. We sought to analyze the impact of the type of tricuspid annuloplasty ring on the atrial arrhythmia behavior and the incidence of permanent pacemaker implantations in patients undergoing mitral valve annuloplasty. Methods: We performed a retrospective review of 408 patients underwent combined tricuspid and mitral valve annuloplasty in our institution between the years 2007 and 2014.Patients were 68,8 ± 10,7 years old, 67% male, 33% female. A total of 325 patients met the inclusion criteria; 201 received three-dimensional (3D) rigid ring (group 1) and 124 received ring annuloplasty with flexible bands (group2). The distribution of the preoperative and perioperative variables was similar. Results: There was no statistical difference in the incidence of high-grade heart conduction disorders lasting more than 3 days postoperatively (13.4% in group 1 and 12.9% in group 2; P = 0.89). Likewise, there was no difference in the incidence of postoperative atrial fibrillation between the two groups (41.2% in group 1 and 37.1% in group 2; P = 0.45). On the other hand, there was statistical difference in the incidence of permanent pacemaker implantation between the two groups (12.9% in group 1 and 25.8% in group 2; P = 0.003). Likewise, there was difference in the incidence of sick sinus syndrome between the two groups (0.01% in group 1 and 16.1% in group 2; P < 0.00001). Conclusion: The need for permanent pacemaker implantation and the incidence of sick sinus syndrom may be increased after the use of flexible tricuspid annuloplasty ring in the setting of mitral valve surgery.Moreover, the present study found no association between the use of Flexible tricuspid annuloplasty ring and a higher incidence of postoperative atrial fibrillation or high-grade heart conduction disorders.Further large-scale randomized controlled studies are needed to elucidate the Impact of the type of tricuspid annuloplasty ring.