Department of Pediatrics, Division of Cardiology, Stanford University, Palo Alto, Calif.
Department of Pediatrics, Division of Critical Care, University of California, San Francisco, San Francisco, Calif.
J Thorac Cardiovasc Surg. 2019 Mar;157(3):1168-1177.e2. doi: 10.1016/j.jtcvs.2018.09.142. Epub 2018 Nov 24.
Our primary aims were to describe the contemporary epidemiology of postoperative high-grade atrioventricular block (AVB), the timing of recovery and permanent pacemaker (PPM) placement, and to determine predictors for development of and recovery from AVB.
Patients who underwent congenital heart surgery from August 2014 to June 2017 were analyzed for AVB using the Pediatric Cardiac Critical Care Consortium registry. Predictors of AVB with or without PPM were identified using multinomial logistic regression. We used these predictors to model the probability of PPM for the subgroup of patients with intraoperative complete AVB.
We analyzed 15,901 surgical hospitalizations; 422 (2.7%) were complicated by AVB and 162 (1.0%) patients underwent PPM placement. In patients with transient AVB, 50% resolved by 2 days, and 94% resolved by 10 days. In patients who received a PPM, 50% were placed by 8 days and 62% were placed by 10 days. Independent risk factors associated with PPM compared with resolution of AVB were longer duration of cardiopulmonary bypass (relative risk ratio, 1.04; P = .023) and a high-risk operation (relative risk ratio, 2.59; P < .001). Among patients with complete AVB originating in the operating room, those with the highest predicted probability of PPM had a PPM placed only 77% of the time.
In this cohort, postoperative AVB complicated almost 3% of congenital heart surgery cases and 1% of patients underwent PPM placement. Because almost all patients (94%) with transient AVB had resolution by 10 days, our results suggest there is limited benefit to delaying PPM placement beyond that time frame.
本研究旨在描述术后高级房室传导阻滞（AVB）的当代流行病学特征、恢复时间和永久性心脏起搏器（PPM）的植入时机，并确定 AVB 发生和恢复的预测因素。
采用儿科心脏危重病护理联合会（PCCCC）注册中心，对 2014 年 8 月至 2017 年 6 月期间接受先天性心脏手术的患者进行 AVB 分析。采用多项逻辑回归确定伴有或不伴有 PPM 的 AVB 的预测因素。我们使用这些预测因素，对术中完全性 AVB 亚组患者的 PPM 植入概率进行建模。
共分析了 15901 例手术住院患者，其中 422 例（2.7%）并发 AVB，162 例（1.0%）患者植入了 PPM。在伴有一过性 AVB 的患者中，50%的患者在 2 天内恢复，94%的患者在 10 天内恢复。在植入 PPM 的患者中，50%的患者在 8 天内植入，62%的患者在 10 天内植入。与 AVB 恢复相比，与 PPM 植入相关的独立危险因素包括体外循环时间较长（相对风险比，1.04；P=0.023）和高危手术（相对风险比，2.59；P<0.001）。在起源于手术室的完全性 AVB 患者中，那些预测 PPM 植入概率最高的患者，只有 77%的患者植入了 PPM。
在本队列中，术后 AVB 使近 3%的先天性心脏病手术患者和 1%的患者需要植入 PPM。由于几乎所有（94%）的一过性 AVB 患者在 10 天内恢复，因此我们的结果表明，在此时间范围之外，延迟 PPM 植入的获益有限。
