Tucker Elliot M, Pyles Lee A, Bass John L, Moller James H
Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA.
J Am Coll Cardiol. 2007 Sep 18;50(12):1196-200. doi: 10.1016/j.jacc.2007.06.014. Epub 2007 Sep 4.
This study sought to discover the incidence of permanent pacemaker (PPM) placement for atrioventricular conduction block (AV block) after operative repair of perimembranous ventricular septal defect (PMVSD) in a large multi-institutional database and in the subgroup of patients comparable to those considered for transcatheter device closure of PMVSD.
Atrioventricular conduction block is a complication of operative repair of PMVSD and of device closure of this defect. Earlier reports do not report the incidence of AV block by VSD type.
The Pediatric Cardiac Care Consortium database was searched for all children who had operative PMVSD repair except those with abnormalities that increase risk of AV block. The patient group was searched for those with subsequent PPM placement for AV block. Demographic data and time to PPM placement were available for all patients.
Of 4,432 patients with PMVSD repair, 48 (1.1%) underwent PPM placement for AV block. The PPM group was more likely to have Down syndrome (41% vs. 18%; p < 0.001), was younger (mean age 14 vs. 26 months; p < 0.001), and had longer mean length of postoperative hospital stays (20 vs. 8 days; p < 0.001). The most significant risk factor for AV block was Down syndrome (odds ratio 3.62, 95% confidence interval 2.02 to 6.39; p < 0.005). Modal time to PPM placement was 7 days (range 0 to 4,078 days). Out of 1,877 patients comparable to those currently considered for device closure, 13 (0.8%) underwent PPM placement after PMVSD repair.
Operative AV block and PPM placement occurred in 1.1% of patients in the total group and in 0.8% of patients comparable to those considered for device closure of PMVSD. A PPM placement is more likely in patients with Down syndrome. These data should be considered as devices are developed and in the future when counseling families about options for PMVSD closure.
本研究旨在通过一个大型多机构数据库，以及在与那些考虑经导管封堵膜周部室间隔缺损（PMVSD）的患者相似的亚组中，探寻在PMVSD手术修复后因房室传导阻滞（AV阻滞）而植入永久起搏器（PPM）的发生率。
房室传导阻滞是PMVSD手术修复及该缺损封堵术的一种并发症。早期报告未按室间隔缺损类型报告AV阻滞的发生率。
在儿科心脏护理联盟数据库中搜索所有接受PMVSD手术修复的儿童，但不包括那些有增加AV阻滞风险异常情况的儿童。在该患者群体中搜索因AV阻滞而随后植入PPM的患者。所有患者的人口统计学数据及植入PPM的时间均可得。
在4432例接受PMVSD修复的患者中，48例（1.1%）因AV阻滞植入PPM。PPM组更可能患有唐氏综合征（41%对18%；p<0.001），年龄更小（平均年龄14个月对26个月；p<0.001），术后平均住院时间更长（20天对8天；p<0.001）。AV阻滞最显著的危险因素是唐氏综合征（比值比3.62，95%置信区间2.02至6.39；p<0.005）。植入PPM的中位时间为7天（范围0至4078天）。在1877例与目前考虑封堵术的患者相似的患者中，13例（0.8%）在PMVSD修复后植入PPM。
在整个患者群体中，手术导致的AV阻滞及PPM植入发生率为1.1%，在与考虑PMVSD封堵术的患者相似的患者中为0.8%。唐氏综合征患者更可能植入PPM。在研发相关器械以及未来为家庭提供PMVSD封堵术选择咨询时，应考虑这些数据。
