Uniat Jonathan, Bar-Cohen Yaniv, Shwayder Mark, Wiggins Luke, Silka Michael J, Hill Allison C
Division of Cardiology, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA.
Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Pediatr Cardiol. 2025 Jan 30. doi: 10.1007/s00246-025-03793-w.
L-transposition of the great arteries (L-TGA) represents a spectrum of congenital heart defects (CHD) associated with atrioventricular block (AVB). However, the incidence and prognosis of postoperative AVB among patients with variants of L-TGA is uncertain. Assess the incidence and risk factors for postoperative AVB requiring permanent pacemaker (PPM) implantation for pediatric patients with L-TGA undergoing cardiac surgery. Single-center retrospective analysis of patients with L-TGA who underwent cardiac surgery from 2000 to 2022. Patients with postoperative AVB and those requiring PPM implantation were compared to those who did not receive a PPM. 161 cardiac surgeries were performed in 75 patients with L-TGA. Postoperative AVB occurred in 8 cases (5%) with 5 cases (3%) requiring PPM. Univariate analysis identified risk factors for PPM which included ventricular septal defect (VSD) intervention [odds ratio (OR) 58.4, p < 0.01], pre-operative non-single-ventricle physiology (OR 13.3, p = 0.02), and longer pre-operative PR interval Z-score (OR 3.3, p < 0.01). Excluding biventricular conversions, no surgery (n = 116) in patients with univentricular circulation required a PPM in the postoperative period due to AVB. Multivariate analysis did not identify any statistically significant risk factors for AVB requiring PPM. The overall risk of postoperative AVB in L-TGA was 5% despite the anatomic vulnerability of the conduction system. However, L-TGA patients appear less likely to recover AV conduction than all comers to CHD surgery (38% L-TGA vs 60% overall, p < 0.01) and may be considered for earlier PPM placement.
大动脉L型转位（L-TGA）是一系列与房室传导阻滞（AVB）相关的先天性心脏缺陷（CHD）。然而，L-TGA变异患者术后AVB的发生率和预后尚不确定。评估接受心脏手术的L-TGA儿科患者术后需要植入永久起搏器（PPM）的AVB的发生率和危险因素。对2000年至2022年接受心脏手术的L-TGA患者进行单中心回顾性分析。将术后发生AVB和需要植入PPM的患者与未接受PPM的患者进行比较。75例L-TGA患者共进行了161次心脏手术。术后8例（5%）发生AVB，5例（3%）需要植入PPM。单因素分析确定了PPM的危险因素，包括室间隔缺损（VSD）干预[比值比（OR）58.4，p<0.01]、术前非单心室生理状态（OR 13.3，p=0.02）和术前PR间期Z评分较长（OR 3.3，p<0.01）。排除双心室转换，单心室循环患者中无手术（n=116）的患者在术后因AVB需要植入PPM。多因素分析未发现任何与需要PPM的AVB具有统计学意义的危险因素。尽管传导系统存在解剖学上的易损性，但L-TGA患者术后AVB的总体风险为5%。然而，L-TGA患者恢复房室传导的可能性似乎低于所有接受CHD手术的患者（L-TGA为38%，总体为60%，p<0.01），可能需要考虑更早植入PPM。
