☆ 4.6 Article

Development and impact of arrhythmias after the Norwood procedure: A report from the Pediatric Heart Network

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY (2017)

期刊

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY

卷 153, 期 3, 页码 638-+

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MOSBY-ELSEVIER

DOI: 10.1016/j.jtcvs.2016.10.078

关键词

arrhythmia; atrioventricular block; mortality; Norwood; outcomes; single ventricle; tachyarrhythmia

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Cardiac & Cardiovascular Systems Respiratory System Surgery

资金

National Heart, Lung, and Blood Institute [HL068269, HL068270, HL068279, HL068281, HL068285, HL068292, HL068290, HL068288, HL085057, HL109781, HL109737]

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Objectives: The study objective was to determine the predictors of new-onset arrhythmia among infants with single-ventricle anomalies during the post-Norwood hospitalization and the association of those arrhythmias with postoperative outcomes (ventilator time and length of stay) and interstage mortality. Methods: After excluding patients with preoperative arrhythmias, we used data from the Pediatric Heart Network Single Ventricle Reconstruction Trial to identify risk factors for tachyarrhythmias (atrial fibrillation, atrial flutter, supraventricular tachycardia, junctional ectopic tachycardia, and ventricular tachycardia) and atrioventricular block (second or third degree) among 544 eligible patients. We then determined the association of arrhythmia with outcomes during the post-Norwood hospitalization and interstage period, adjusting for identified risk factors and previously published factors. Results: Tachyarrhythmias were noted in 20% of subjects, and atrioventricular block was noted in 4% of subjects. Potentially significant risk factors for tachyarrhythmia included the presence of modified Blalock-Taussig shunt (P = .08) and age at Norwood (P = .07, with risk decreasing each day at age 8-20 days); the only significant risk factor for atrioventricular block was undergoing a concomitant procedure at the time of the Norwood (P = .001), with the greatest risk being in those undergoing a tricuspid valve procedure. Both tachyarrhythmias and atrioventricular block were associated with longer ventilation time and length of stay (P <. 001 for all analyses). Tachyarrhythmias were not associated with interstage mortality; atrioventricular block was associated with mortality among those without a pacemaker in the unadjusted analysis (hazard ratio, 2.3; P = .02), but not after adding covariates. Conclusions: Tachyarrhythmias are common after the Norwood procedure, but atrioventricular block may portend a greater risk for interstage mortality.

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Long-term outcomes of atrioventricular septal defect and single ventricle: A multicenter study

Sara C. Arrigoni, Rinske IJsselhof, Douwe Postmus, Judith M. Vonk, Katrien Francois, Thierry Bove, Mark G. Hazekamp, Friso M. Rijnberg, Bart Meyns, Joeri van Puyvelde, Alain J. Poncelet, Geoffroy de Beco, Pieter C. van de Woestijne, Ad J. J. C. Bogers, Paul H. Schoof, Tjark Ebels

Summary: The study analyzed the survival and incidence of Fontan completion in patients with single-ventricle atrioventricular septal defect. The results showed that patients with moderate-severe or severe atrioventricular valve regurgitation had a worse survival, and repairing the atrioventricular valve could improve the survival rate. This study provides important information for the diagnosis and treatment of these patients.

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