Incidence and Outcomes of Iatrogenic Complete Atrioventricular Block After Congenital Heart Surgery.

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2024-09-12 DOI:10.1016/j.athoracsur.2024.09.002

Mario O'Connor, Andrew Well, Arnold Fenrich, Neil M Venardos, Daniel Shmorhun, Carlos M Mery, Charles D Fraser

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Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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先天性心脏病手术后先天性完全性房室传导阻滞的发生率和预后。

背景：长期以来，先天性完全性房室传导阻滞（ICAVB）一直是先天性心脏病手术（CHS）后的主要并发症，导致术后护理复杂，并可能影响患者的预后：方法：对 2004 年 1 月 1 日至 2009 年 3 月 30 日的儿科健康信息系统数据库进行回顾性分析。所有接受过胸外科医师协会基准手术的患者均被纳入其中。国际疾病分类》第 9 版和第 10 版用于确定诊断和手术。所有诊断为CAVB并在CHS后安置永久起搏器但在同一医院住院的患者均被确定为ICAVB患者：共有 42,332 名患者被确定为 ICAVB 患者，其中 17,106 人（41%）为女性，23,042 人（55%）为非西班牙裔白人，中位年龄为 5.4 个月[IQR:0.4-25.8]。其中，246 人（0.6%）患有先天性 CAVB。先天性 CAVB 发生率最高的手术是动脉转流手术加室间隔缺损修补术（ASO+VSD）（74/1552，4.5%）。经多变量分析，ASO+VSD 的先天性 CAVB 调整后几率最高（OR:5.41 (95%CI:3.57-8.19), p结论：CHS 后先天性 CAVB 的总体发生率较低。然而，某些手术的发生率高达 4.5%。先天性 CAVB 与术后死亡率和住院时间增加有关。需要进一步开展工作，找出造成各中心之间差异的原因，以改善总体结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.