Marca-passo cardíaco definitivo em crianças com bradicardia pós-operatória: resultados tardios

Abstract

RBCCV 44205-777 Marca-passo cardíaco definitivo em crianças com bradicardia pós-operatória: resultados tardiosPermanent cardiac pacing in children with postoperative bradycardia: long-term follow-up Abstract Objective: To evaluate the long-term outcomes of children submitted to permanent cardiac pacing due to postoperative bradycardia and to identify risk factors for mortality.Methods: From 1980 to 2004, 120 children were submitted to permanent pacemaker implantation. Interval between the defect correction and pacemaker implantation was 1.2 ± 2.8 years on average (median = 21 days). Atrioventricular blocks were present in 94.2% of patients. Transvenous leads (78.3%) and ventricular pacemaker systems (79.2%) were used in most cases. Risk factors were studied using the Cox proportional model. The Kaplan-Meier method and the Log-Rank test were used to analyze survival.Results: After a mean of 5.7 ± 5.9 years (maximum = 22.5 years) of follow-up, 97 patients were alive and 23 were lost from the follow-up study. The main causes of death were terminal heart failure (10), infection not related to implantation (six), and sudden death (three). The 5-, 10-, and 15-year survival rates were 80.9 ± 4.1%, 75.4 ± 5.5% and 67.2 ± 7.4%, respectively. The persistence of hemodynamic problems (palliative procedures, the use of valve prostheses or the presence of residual defects) was identified as the only independent risk predictors for mortality, with significant alterations in the survival curves (p=0.0123).Conclusion: The implant of permanent pacemakers in children provided good survival expectancy, mainly depending on the underlying disease and the type of the correction made. Palliative corrections, such as the presence of residual defects or the use of valve prostheses were the only predictors of poor results in these children. Descriptors: Cardiac pacing, artificial. Heart block. Pediatrics. Cardiac surgical procedures. Postoperative complications. COSTA, R ET AL -Permanent cardiac pacing in children with postoperative bradycardia: long-term follow-up Braz J Cardiovasc Surg 2005; 20(4): 392-397 Resumo Objetivo: Avaliar a evolução tardia de crianças com marcapasso definitivo por bradicardia pós-operatória, e identificar fatores de risco para a mortalidade. Método: De 1980 a 2004, 120 crianças receberam implante de marca-passo definitivo por bradicardia pós-operatória. O intervalo médio entre a correção do defeito e o implante foi de 1,2 ± 2,8 anos, com mediana de 21 dias. Bloqueio atrioventricular esteve presente em 94,2% dos pacientes. A via de acesso transvenosa (78,3%) e marca-passos (MP) definitivos ventriculares (79,2%) foram os mais utilizados. Empregou-se o método de Kaplan-Meier e o teste de Log-Rank para a análise de sobrevivência.Resultados: Após 5,7 ± 5,9 anos de seguimento (máximo= 22,5 anos), 97 pacientes estavam vivos e 11 haviam sido perdidos para o seguimento. As principais causas de morte foram insuficiência cardíaca (10), infecção não relacionada ao marca-passo (seis) e morte súbita (três). A expectativa de s...