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• W4377016032 abstract "L-transposition of the great arteries (LTGA) is a rare congenital heart defect (CHD) representing 0.5% of CHD and characterized by atrioventricular (AV) and ventriculoarterial discordance. Due to the abnormal AV relationship, LTGA patients are at risk for both spontaneous and postoperative complete heart block (CHB). However, data is lacking specifically for the risk for CHB in LTGA patients undergoing cardiac surgery. Describe the incidence and risk factors for surgical CHB for pediatric patients with LTGA. Pediatric LTGA patients, 0-21 years of age, undergoing any cardiac surgery between 2000–2022 at our center were included. Patients with a new diagnosis of postoperative CHB were identified, and those who required permanent pacemaker placement during the same hospitalization were compared to LTGA patients not requiring permanent pacing. Of 161 LTGA surgeries, acute postoperative CHB occurred in 6 cases (4%) with permanent pacemaker implantation in 5 patients during the same hospitalization. Patients requiring permanent pacemaker placement weighed more (23 vs 7 kg, p=0.02), were more likely to have two ventricular physiology (80% vs 23%, p=0.01), and have a longer pre-operative PR z-score (1.2 vs -0.1, p<0.01). Additionally, the pacemaker group was more likely to have had ventricular septal defect (VSD) closure (80% vs 6%, p<0.01), a longer cardiopulmonary bypass time (149 vs 54 min, p=0.03), and a longer cross clamp time (106 vs 2 min, p<0.01). One of six (17%) patients who had post-operative CHB had AV nodal recovery 3 days postoperatively. In comparing our LTGA cohort to a historical cardiac surgical cohort of all CHD patients (Romer 2019, JTCVS), there was no significant difference in the incidence of post-operative CHB (4% vs 3%, p=0.4), but the LTGA cohort more frequently required permanent pacing compared to the historical surgical cohort of all CHD (3% vs 1%, p=0.01). A pre-operative diagnosis of LTGA may not portend a higher risk of postoperative CHB compared to contemporary cardiac surgical data for all CHD patients, but the CHB in LTGA patients is more likely to be persistent and require permanent pacemaker implantation. LTGA patients requiring post-operative permanent pacemakers are most likely to have had a VSD closure." @default.
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• W4377016032 date "2023-05-01" @default.
• W4377016032 modified "2023-09-26" @default.
• W4377016032 title "PO-03-150 INCIDENCE OF HEART BLOCK IN PEDIATRIC PATIENTS WITH L-TRANSPOSITION OF THE GREAT ARTERIES UNDERGOING CARDIAC SURGERY" @default.
• W4377016032 doi "https://doi.org/10.1016/j.hrthm.2023.03.961" @default.
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