Abstract 12910: Safety and Utility of Cardiac Catheterization in the Early Postoperative Period Following Congenital Cardiac Surgery

Abstract

Introduction: In patients with clinical concern for residual anatomic or physiologic lesions after congenital cardiac surgery, the risk to benefit ratio of early postoperative cardiac catheterization (EPOC) remains unclear. Methods: Retrospectively, patients undergoing EPOC (catheterization ≤42 days after surgery and prior to discharge) were identified from a single institutional database between 1/1/06 to 10/31/13. Patient, procedural and high-severity adverse event (HSAE) data were obtained from the Congenital Cardiac Catheterization Outcomes Project. Univariate analysis identified risk factors for HSAEs and a multivariable model was created to describe their relationship. Utility of EPOC was determined by re-intervention (surgical and/or catheter-based). Results: In the cohort, 561 EPOCS occurred on median POD 10 (5, 19) in 413 subjects with median age of 4.6 mos (3.2, 9.9) and weight 4.4 kg (0.8, 18.2). The majority of cases were not elective (92%), performed on inotropes (62%) and mechanically ventilated (96%). Residual defects were found in 75% of the cases: 50% requiring catheter-based interventions, 15% necessitating re-operation and 10% underwent both catheter-based intervention and re-operation. There were 70 HSAEs (12.5%) including 1 death, 2 emergent surgeries and 5 ECMO cannulations. Vascular tears occurred at surgical anastomotic sites in 11 of 198 (6%) cases involving angioplasty. HSAEs were associated with low patient weight (p=0.02), interventional procedures (p=0.03), greater number of interventions (p<0.01), higher procedure risk group (p=0.03), blood transfusion (p<0.01) and longer case duration (p<0.01). In multivariable analysis, HSAEs were associated with case duration (OR 1.008, 95% CI 1.003-1.012), blood transfusion (OR 0.431, 95% CI 0.25-0.745) and male gender (OR 0.573, 95% CI 0.331-0.992). Time from surgery to EPOC was not associated with an increased rate of HSAEs (p=0.5). Conclusions: EPOC carried an increased rate of HSAEs with no association between POD and the rate of HSAEs. EPOC identified significant residual defects in the majority of patients necessitating re-intervention. EPOC should be considered in patients with unexpected cardiopulmonary concerns following congenital cardiac surgery.