Related Experiment Video
Updated: Jun 13, 2025
Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
Incidence and Outcomes of Iatrogenic Complete Atrioventricular Block After Congenital Heart Surgery
Mario O'Connor1, Andrew Well1, Arnold Fenrich2
1Department 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.
Insights
Iatrogenic complete atrioventricular block (ICAVB) after congenital heart surgery (CHS) is rare but linked to longer hospital stays and higher mortality. The arterial switch operation with VSD repair shows the highest ICAVB risk.
Area of Science:
- Cardiology
- Pediatric Surgery
- Medical Complications
Background:
- Iatrogenic complete atrioventricular block (ICAVB) is a significant complication following congenital heart surgery (CHS).
- ICAVB can complicate postoperative care and impact patient outcomes.
Purpose of the Study:
- To determine the incidence, risk factors, and outcomes associated with ICAVB after CHS.
- To identify specific procedures associated with a higher risk of ICAVB.
Main Methods:
- Retrospective review of the Pediatric Health Information System database (2004-2023).
- Inclusion of patients undergoing Society of Thoracic Surgeons benchmark procedures.
- Identification of ICAVB using ICD-9/10 codes for complete atrioventricular block and permanent pacemaker placement post-CHS within the same hospitalization.
Main Results:
- A total of 42,332 patients were analyzed, with 246 (0.6%) diagnosed with ICAVB.
- The arterial switch operation with VSD repair had the highest incidence (4.5%) and adjusted odds of ICAVB (OR, 5.41).
- ICAVB was associated with a 121% increase in length of stay and a 2.26-fold increase in in-hospital mortality.
Conclusions:
- While the overall incidence of ICAVB after CHS is low, specific procedures like the arterial switch operation with VSD repair carry a significantly higher risk.
- ICAVB is a critical complication associated with increased length of stay and mortality.
- Further research is needed to understand center-specific variations and improve patient outcomes.
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.
