JUAN CRESTANELLO: Welcome to the Cardiovascular Surgery Series, where I review the latest research in cardiovascular surgery from the Mayo Clinic in just two minutes. I am Dr. Juan Crestanello, a cardiac surgeon at the Mayo Clinic in Rochester, Minnesota. We're going to discuss today the outcomes of tricuspid valve surgery in the presence of permanent pacemaker.

We reviewed 622 patients with tricuspid valve regurgitation and pacing leads. From the ideological standpoint we divided those patients in two groups-- lead-associated and lead-induced tricuspid regurgitation. In patients with lead-associated tricuspid regurgitation, the lead is a bystander.

Those patients had less of an isolated tricuspid valve surgery since the tricuspid regurgitation is secondary to other cardiac conditions. Since the lead is not causing the tricuspid regurgitation, tricuspid valve repair is more often achieved. However, because of the concomitant cardiac comorbidities, those patients had a higher operative mortality. Patients with lead-induced tricuspid regurgitation more often had isolated tricuspid valve surgery, but because of the destruction caused by the lead on the tricuspid valve, tricuspid valve repair is less often accomplished. The operative mortality is lower, and the long-term survival is better.

The main mechanisms of lead-induced tricuspid regurgitation are restricted mobility, a scarring and fusion, chordal entrapment, and leaflet perforation by the lead. We conclude that lead-induced tricuspid regurgitation is associated with better outcomes, a lower rate of repair, and improved long-term survival. Thank you for listening to the Mayo Clinic Cardiovascular Surgery Series.