Incidence of Permanent Pacemaker Implantation Following Tricuspid Valve Surgeries: A Systematic Review and Meta-Analysis

Objective: Tricuspid valve (TV) surgery is increasingly performed. Still, the risk of permanent pacemaker (PPM) implantation following TV surgery is a serious concern. Therefore, the present systematic review and meta-analysis is aimed to determine the incidence of PPM implantation following TV surgeries in various surgical settings. Methods: This study was preregistered in PROSPERO (CRD42024585421). A methodical search was performed across various international electronic databases. Random-effects models were used to illustrate the aggregated incidence of PPM implantation following different types of TV surgeries. Meta-regression and subgroup analysis were applied to evaluate the statistically significant effect of modifiers. Results: Twelve studies were included; a total of 18,437 patients underwent TV surgery. The incidence of PPM implantation following overall TV surgery was 12.1% ( P < 0.001), isolated TV surgery was 11.1% ( P < 0.001), TV + mitral valve (MV) surgery was 12.3% ( P < 0.001), TV + aortic valve (AV) surgery was 10.9% ( P = 0.001), and TV + MV + AV surgery was 17.3% ( P < 0.001). Conclusions: PPM implantation is a common complication that can arise after TV surgery, especially when multiple valves are involved. Although substantial variability across studies makes it difficult to pinpoint exact risks, the overall message is clear: there is a need to focus on preoperative patient counseling and develop standardized research to improve our ability to predict and prevent these complications.