Hussain B, Dhulipala V, Jafry AH, and Basir MB. CRT-700.53 Risk of Heart Block Development in Surgical Management of Congenital Heart Disease. JACC Cardiovasc Interv 2023; 16(4):S99.
JACC Cardiovasc Interv
Background: There is a paucity of data regarding the risk for heart block during surgical repair of congenital heart disease (CHD). We sought to identify the prevalence and prognosis of heart block in patient’s requiring surgical intervention for CHD.
Methods: National Inpatient Sample 2016-2019 was used to conduct a retrospective analysis by identifying a cohort of patients admitted for surgical management for atrial septal defect repair/replacement (ASDR), ventricular septal defect repair/replacement (VSDR) and patent ductus arteriosus closure (PDAC) using respective ICD-10 codes. Primary outcome was the risk of developing heart blocks including atrioventricular and bundle branch/fascicular blocks which was assessed with multivariate logistic regression model.
Results: 7.6% patients with ASD underwent ASDR, 10.4% patients with VSD underwent VSDR and 8.8% patients with PDA underwent PDAC. Heart blocks were observed in 12% of ASD patients undergoing ASDR, 10% of VSD patients undergoing VSDR and 8.8% of PDA patients undergoing PDAC. Mean age was 38.9 years for patients undergoing ASDR developing heart blocks, 11.48 years for patients undergoing VSDR developing heart blocks and 10.3 months for patients undergoing PDAC developing heart blocks. On analysis of patients who developed heart blocks after undergoing surgery for CHD, we found that 51.5% were males, 48.4% were females, 57.8% were white, 12.7% were African-American and 17.6% were Hispanic. ASDR was associated with increased odds of developing heart blocks in patients with ASD (OR 3.89, CI 3.6-4.2, p<0.001) and VSDR was associated with increased odds of developing heart blocks in VSD patients (OR 9.31, CI 8-10.7, p<0.001). While, PDAC was associated with even higher odds of developing heart blocks in PDA patients (OR 12.75, CI 10.4-15.6, p<0.001). ASDR was associated with decreased mortality in ASD patients (OR 0.85, CI 0.74-0.98, p=0.036), VSDR had no significant association with mortality in VSD patients (OR 0.99, p=0.9) and PDAC was associated with minimally increased mortality (OR 1.16, CI 1.001-1.36, p=0.04).
Conclusion: Heart blocks are prevalent among the patients undergoing surgical treatment for CHD. Surgical repair of CHD is strongly associated with the risk of developing heart blocks, highest risk being with PDAC followed by VSDR and ASDR.