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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Sinus node dysfunction after surgery for congenital heart disease: Incidence and impact on recovery
Omar Meziab1, Maria M Pærregaard2, Eric Feins2
1Boston Children's Hospital, Boston, MA; University of Arizona, Tucson, AZ.
Insights
Sinus node dysfunction (SND) after congenital heart surgery impacts outcomes, occurring in 17.2% of cases. While most patients recover, SND is linked to longer hospital stays and adverse events.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Sinus node dysfunction (SND) is a recognized complication following congenital heart disease (CHD) surgery.
- The post-operative course and specific outcomes associated with SND after CHD surgery require further characterization.
Purpose of the Study:
- To determine the incidence of post-operative SND in pediatric cardiac surgery patients.
- To evaluate the impact of SND on post-operative outcomes, including length of stay and adverse events.
Main Methods:
- A retrospective study analyzed 4571 pediatric cardiac surgeries performed between 2013 and 2017.
- SND was defined by bradycardia, junctional rhythm, or need for atrial pacing, and sub-categorized into Absolute and Relative SND.
- Post-operative outcomes were compared across groups with no SND, Absolute SND, and Relative SND.
Main Results:
- SND occurred in 17.2% of surgeries (786/4571), with Absolute SND in 695 and Relative SND in 91 cases.
- Absolute SND was most frequent after surgeries involving pulmonary veins, mitral valve, atrial baffle, Glenn, and Fontan procedures.
- SND cases experienced longer hospital and ICU stays, delayed extubation, and a higher incidence of major adverse cardiac events compared to controls.
Conclusions:
- SND is a significant complication, particularly after complex CHD surgeries like Fontan palliation and those involving the mitral valve.
- While 89% of patients recovered from SND before discharge, 11% had persistent dysfunction, associated with poorer outcomes.
- Permanent atrial pacing was required in 2% of all surgeries with post-operative SND, highlighting the long-term implications.
Background:
Sinus node dysfunction (SND) is a known complication after surgery for congenital heart disease; however, its postoperative course is not well characterized.
Objective:
This study aimed to describe the incidence of postoperative SND and its impact on postoperative outcomes.
Methods:
This was a retrospective study of children aged 0-18 years after cardiac surgery in 2013-2017. SND is defined as bradycardia for age, junctional escape rhythm, or use of postoperative atrial pacing for bradycardia. SND was subcategorized as either absolute SND (sinus bradycardia for age or junctional rhythm <100 beats/min) or relative SND (normal sinus rate with hemodynamic need for atrial pacing). Postoperative outcomes were compared in surgeries with no postoperative SND, absolute SND, and relative SND.
Results:
Of the 4571 surgeries (age 1 year; interquartile range 0.2-4.5), SND occurred in 786 surgeries (17.2%) (absolute 695; relative 91). Absolute SND was most common after surgery involving pulmonary veins (31%), mitral valve (27%), atrial baffle creation (27%), Glenn palliation (26%), and Fontan palliation (26%). Relative SND was most common after stage 1 palliation (10%). Most surgeries (89%) recovered from SND before discharge, with a median recovery time of 31.9 hours. Surgeries with SND had longer hospital and intensive care unit length of stay, longer time to extubation, and a higher incidence of major adverse cardiac events.
Conclusion:
SND occurs in more than 25% of surgeries involving pulmonary veins, mitral valve, atrial baffle creation, and Glenn and Fontan palliation. Stage 1 palliation frequently requires pacing for hemodynamic needs. SND persists at discharge in 11% and is associated with worse postoperative outcomes. Permanent atrial pacing need was found in 2% of all surgeries with postoperative SND.
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