Lin Li, Chen Wanhua, Chen Hang, Liu Jianwen, Chen Kanghui, Chen Lianglong, Chen Liangwan, Chen Zhaoyang
Department of Cardiology, Heart Center of Fujian Province, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China.
Acta Cardiol. 2025 May;80(3):266-273. doi: 10.1080/00015385.2025.2480961. Epub 2025 Mar 31.
Complete atrioventricular conduction block (CAVB) is a major complication of the repair and occlusion of perimembranous ventricular septal defects (pmVSDs).
This study aimed to analyse the incidence and risk factors of CAVB after occlusion and repair of pmVSD.
We reviewed patients with pmVSDs who underwent occlusion and repair between January 2010 and January 2022. Permanent CAVB was defined as a CAVB requiring permanent pacemaker implantation or occluder extraction.
Of 2436 patients who underwent pmVSD repair, 7 (0.3%) developed permanent CAVB. In all, 16 (0.7%) of the 2200 patients in the device group developed permanent CAVBs. All permanent CAVBs in the repair group occurred during hospital stay. In contrast, eight (50%) permanent CAVBs in the device group occurred over 1 month. A large pmVSD size (odds ratio [OR], 1.575; 95% confidence interval [CI], 1.260-1.970, < 0.001) and device/defect ratio (OR, 2.608; 95% CI, 1.587-4.287, < 0.001) were independent risk factors for permanent CAVB after surgical repair and device occlusion, respectively. Multivariate regression showed that device occlusion versus surgical repair was associated with a significantly higher risk of permanent CAVBs (OR, 4.675; 95% CI, 1.586-13.780, = 0.005).
The incidence rates of permanent CAVB after device occlusion and surgical repair were 0.7% and 0.3%, respectively. Large VSD size and device/defect ratio were independently associated with permanent CAVB after surgical repair and device occlusion, respectively. Compared with surgical repair, device occlusion was associated with a significantly higher risk of permanent CAVB after pmVSD closure.
完全性房室传导阻滞（CAVB）是膜周部室间隔缺损（pmVSDs）修补和封堵术后的主要并发症。
本研究旨在分析pmVSD封堵和修补术后CAVB的发生率及危险因素。
我们回顾了2010年1月至2022年1月期间接受封堵和修补的pmVSD患者。永久性CAVB定义为需要植入永久性起搏器或取出封堵器的CAVB。
在2436例行pmVSD修补术的患者中，7例（0.3%）发生永久性CAVB。在器械组的2200例患者中，共有16例（0.7%）发生永久性CAVB。修补组所有永久性CAVB均发生在住院期间。相比之下，器械组8例（50%）永久性CAVB发生在术后1个月以上。大的pmVSD尺寸（比值比[OR]，1.575；95%置信区间[CI]，1.260 - 1.970，P < 0.001）和器械/缺损比值（OR，2.608；95% CI，1.587 - 4.287，P < 0.001）分别是手术修补和器械封堵术后永久性CAVB的独立危险因素。多因素回归分析显示，与手术修补相比，器械封堵发生永久性CAVB的风险显著更高（OR，4.675；95% CI，1.586 - 13.780，P = 0.005）。
器械封堵和手术修补术后永久性CAVB的发生率分别为0.7%和0.3%。大的室间隔缺损尺寸和器械/缺损比值分别与手术修补和器械封堵术后的永久性CAVB独立相关。与手术修补相比，pmVSD封堵术后器械封堵发生永久性CAVB的风险显著更高。
