Adverse Events Following Cardiac Catheterization among Infants, Children, and Young Adults on Ventricular Assist Device Support

Abstract

Children on ventricular assist device (VAD) support often present unique challenges, such as small size, univentricular or biventricular congenital heart disease (1V- or 2V-CHD), and need for biventricular (BiVAD) support. While cardiac catheterization (cath) can provide valuable information in the management of pediatric patients on VAD support, it is an invasive procedure with inherent risks. We sought to evaluate the safety of cath in this population. We performed a retrospective review of patients on VAD support who underwent cath at a single pediatric VAD center between 2014 and 2019. Using definitions based on Pedimacs, adverse events (AEs) following cath were identified, including respiratory failure (persistent need for intubation ≥ 48 hours post-cath), acute kidney injury (AKI), or arrhythmia within 24 hours, and stroke, pericardial effusion, device malfunction, infection, and death within 7 days. AEs were reviewed by two cardiologists, blinded to each other's assessments, and categorized as directly related or unrelated to cath. Strokes were unrelated to cath if there was documentation of baseline neurologic status after cath but prior to stroke. Descriptive statistics were employed. There were 60 caths on 39 patients. Median age was 11 years (range 2 months - 22 years) and median weight was 36 kg (3.8 - 99.2). Underlying diagnoses included dilated cardiomyopathy (DCM) (54%), 1V-CHD (31%), 2V-CHD (10%), hypertrophic cardiomyopathy (2.5%) and re-transplant (2.5%); 10% were on BiVAD support. Devices were paracorporeal pulsatile (20%), durable continuous flow (72%), and temporary continuous flow (8%). Caths were performed at a median 50 days (6 - 311) from VAD implant; 60% (36/60) were performed on patients in the intensive care unit. Of the 60 caths, there were 7 AEs following cath believed to be directly or possibly related to cath (12%, 7/60), occurring in 6 patients (2 DCM, 3 1V-CHD, 1 other): 1 major bleeding event, 1 AKI, 2 moderate pericardial effusions, and 3 episodes of respiratory failure. There were no strokes, arrhythmia, infections, or mortality attributable to cath. Despite medical complexity such as small size, complex CHD and intensive care needs, cardiac catheterization can be performed with an acceptable adverse event profile in infants, children and young adults on VAD support.