Paravalvular positioning of a cardiac implantable electronic device electrode during tricuspid valve replacement.

Introduction: Patients who need tricuspid valve replacement (TVR) surgery often have permanent transvalvular pacemaker (PM) leads, which pose an important challenge in lead management.

Aim: The objective of this study was to evaluate the results of paravalvular positioning of a permanent pacemaker lead during TVR surgery.

Material and methods: Between 2014 and 2024, a total of 15 patients who had previously had a transvenous pacemaker system underwent TVR. Relevant information, with a focus on pacemaker characteristics, was collected retrospectively.

Results: A total of 15 patients with PM lead previously implanted underwent TVR during the study period. The median time interval between pacemaker implantation and TVR was 8.5 years (5.7-10.5 years). The preoperative median threshold amplitude and impedance values were 1 V (0.68-1.25 V) and 518 Ω (377.5-598.7 Ω), whereas the postoperative median threshold amplitude and impedance values were 0.73 V (0.5-1 V) and 460 Ω (378.5-550). During the midterm follow-up, there were no mortalities or significant morbidities, and no patients required pacemaker lead revision.

Conclusions: We concluded that paravalvular positioning of the PM lead is an acceptable option during TVR surgery, since this technique enables better function of the prosthetic valve and pacemakers at mid-term follow-up.