Evaluation of Permanent or Transient Complete Heart Block after Open Heart Surgery for Congenital Heart Disease

BackgroundThe features of pediatric patients with postoperative transient and permanent complete atrioventricular (AV) block (CAVB) were compared. MethodsPatients who developed CAVB in postoperative period after congenital cardiac surgery between 2010-2015 were included in the study. They were classified as patients with transient CAVB and with permanent CAVB. The demographics and perioperative and postoperative variables of the groups were evaluated. ResultsA total of 1,550 patients underwent surgery during the study period. CAVB was determined in 96 patients (6.2%) in the early postoperative period: 66 had transient CAVB, 30 had permanent CAVB that necessitated pacemaker implantation. The median body weight and age at surgery were similar in both groups. The most frequent diagnosis was tetralogy of Fallot (TOF, n = 22), complete AV septal defect (AVSD, n = 15), and ventricular septal defect (n = 13). Junctional ectopic tachycardia (JET) developed in 27 patients with transient CAVB and in four with permanent CAVB (P < 0.05). There were no significant differences in the congenital cardiac pathology, the cardiopulmonary bypass time, cross-clamp time, and the presence of preoperative arrhythmia between the groups (P > 0.05). The duration of intensive care unit stay was 6 days (range 2-25) for patients with transient CAVB and 13 days (range 4-90) for patients with permanent CAVB. The duration of hospital stay was 10 days (range 2-33) for patients with transient CAVB and 20 days (range 10-90) for patients with permanent CAVB. Both were significantly longer in the patients with permanent CAVB. ConclusionsComplete AVSD and TOF are the most risky operations for the development of postoperative AV block. Ninety-seven percent of the patients with transient CAVB regained AV conduction within the first 10 postoperative days. The high incidence of JET in patients with transient CAVB was striking.