Postoperative Atrioventricular Block After Surgery for Congenital Heart Disease: Incidence, Recovery and Risks

This retrospective study of 9,765 congenital heart surgeries found that atrioventricular block complications in 3.4 percent of cases, with 1.9 percent requiring permanent pacemaker implantation. The highest incidence was observed in patients with congenitally corrected transposition of the great arteries (27.3 percent), Konno procedures (20 percent), mitral valve replacement (16 percent), and complex arterial switch operations (15 percent). For transient blocks (1.4 percent), the median resolution time was four days, with 75 percent resolving by day seven and 90 percent by day 12. Risk factors included older age at the time of operation, preoperative endocarditis, longer aortic cross-clamp time, and high-risk procedures. The findings suggest that permanent pacemaker implantation should be delayed until at least the 12th postoperative day to avoid unnecessary device placement.