Tricuspid Valve Surgery without Transplanting Transvenous Pacing Systems

(Department of Cardiovascular Surgery, Yotsuba Circulation Clinic, Matsuyama, Japan)

Yuichiro Yokoyama Harumitsu Satoh
Transvenous pacemaker leads may impair tricuspid valve coaptation, and is a well-known cause of tricuspid regurgitation(TR). The mechanism underlying TR may be the perforation or laceration of the valve leaflets, direct lead interference with the valve closure, or adhesion of scar tissue between the leads of the pacemaker and the valve leaflet. Recently, three-dimensional echocardiography has clarified the pathway of the pacing lead and its interference with the tricuspid valve, but surgical treatment is not conventionally performed in the early stages of TR because of the necessity of the pacing lead. Occasionally, patients with TR develop severe right-sided heart failure, and the operative mortality in such conditions is very high. Thus, it is important to study the relationship between transvenous leads and TR. Tricuspid valve surgery is usually performed after replacing the transvenous lead with an epicardial lead. However removal of the transvenous lead may cause injury to the right ventricle, and ventricular chronic stimulation thresholds with epicardial stimulation have been shown to be significantly higher than those with endocardial stimulation. We performed TR surgery in 5 patients without removing the transvenous leads. To avoid interference with the valve closure, we shifted the pacemaker leads to the commissure and fixed them to the annulus. All the patients underwent successful tricuspid valve repair or replacement, and the symptoms of right-sided heart failure improved after the operation. We concluded that this technique is a very simple, and feasible method for treatment of most patients with TR caused by pacing leads.
  Jpn. J. Cardiovasc. Surg. 41:219-223(2012)

Keywords:tricuspid valve regurgitation, pacemaker lead, lead fixation