O'Connor Mario, Well Andrew, Fenrich Arnold, Venardos Neil M, Shmorhun Daniel, Mery Carlos M, Fraser Charles D
Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin Texas; Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin Texas; Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center and UT Health Austin, Austin Texas.
Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin Texas; Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin Texas; Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center and UT Health Austin, Austin Texas.
Ann Thorac Surg. 2025 Mar;119(3):586-593. doi: 10.1016/j.athoracsur.2024.09.002. Epub 2024 Sep 12.
Iatrogenic complete atrioventricular block (ICAVB) has long been noted as a major complication after congenital heart surgery (CHS), and it contributes to complex postoperative care and potentially affects patients' outcomes.
This study is a retrospective review of the Pediatric Health Information System database from January 1, 2004 to September 30, 2023. All patients who underwent The Society of Thoracic Surgeons benchmark procedures were included. International Classification of Diseases (ICD) 9th and 10th editions were used to identify diagnoses and procedures. All patients with a diagnosis of complete atrioventricular block and placement of a permanent pacemaker after CHS but in the same hospitalization were identified as having ICAVB.
A total of 42,332 patients were identified, with 17,106 (41%) female and 23,042 (55%) non-Hispanic White and with a median age of 5.4 months [interquartile range, 0.4-25.8 months]. Of those patients, 246 (0.6%) had ICAVB. The procedure with the highest incidence of ICAVB was the arterial switch operation with ventricular septal defect (VSD) repair (74 of 1552; 4.5%). On multivariable analysis, the arterial switch operation with VSD repair had the highest adjusted odds of ICAVB (odds ratio, 5.41; 95% CI, 3.57-8.19; P < .001) when compared with isolated VSD repair. A diagnosis of endocarditis was significantly associated with ICAVB. Center volume was not associated with ICAVB. ICAVB was associated with a 121% (95% CI, 98.5%-146.8%) increase in length of stay (P < .001) and increased in-hospital mortality (odds ratio, 2.26; 95% CI, 1.34-3.82; P < .001).
The overall incidence of ICAVB after CHS is low. However, certain procedures have incidences as high as 4.5%. ICAVB is associated with increased postoperative mortality and length of stay. Further work is needed to identify drivers of variation among centers to improve overall outcomes.
医源性完全性房室传导阻滞（ICAVB）长期以来一直被视为先天性心脏手术（CHS）后的主要并发症，它导致术后护理复杂，并可能影响患者的预后。
本研究是对2004年1月1日至2023年9月30日儿科健康信息系统数据库的回顾性分析。纳入所有接受了胸外科医师协会基准手术的患者。使用国际疾病分类（ICD）第9版和第10版来确定诊断和手术。所有在先天性心脏手术后但在同一住院期间被诊断为完全性房室传导阻滞并植入永久性起搏器的患者被确定为患有ICAVB。
共识别出42332例患者，其中女性17106例（41%），非西班牙裔白人23042例（55%），中位年龄为5.4个月[四分位间距，0.4 - 25.8个月]。在这些患者中，246例（0.6%）患有ICAVB。ICAVB发生率最高的手术是动脉调转术联合室间隔缺损（VSD）修复（1552例中的74例；4.5%）。多变量分析显示，与单纯VSD修复相比，动脉调转术联合VSD修复发生ICAVB的校正比值比最高（比值比，5.41；95%置信区间，3.57 - 8.19；P <.001）。心内膜炎诊断与ICAVB显著相关。中心手术量与ICAVB无关。ICAVB与住院时间延长121%（95%置信区间，98.5% - 146.8%）相关（P <.001），且住院死亡率增加（比值比，2.26；95%置信区间，1.34 - 3.82；P <.001）。
先天性心脏手术后ICAVB的总体发生率较低。然而，某些手术的发生率高达4.5%。ICAVB与术后死亡率增加和住院时间延长相关。需要进一步开展工作以确定各中心之间差异的驱动因素，从而改善总体预后。
