Abstract
BackgroundCardiac catheterization after congenital heart surgery may play an important role in the diagnosis and management of patients with a complicated or unusual post-operative course. The main objective of this study was to evaluate the safety, efficacy, and outcome of cardiac catheterization performed in the early post-operative period following congenital heart surgery. All patients who underwent cardiac catheterization after congenital heart surgery during the same admission of cardiac surgery from November 2015 to May 2018 were included in the study.ResultsThirty procedures were performed for 27 patients (20 interventional and 10 diagnostic). The median age of the patients was 15 months (15 days to 20 years), median weight was 8.2 kg (3.4 to 53 kg), and median time from surgery was 3 days (0–32 days). Eleven procedures were performed for 11 patients on extracorporeal membrane oxygenation (ECMO) support. The main indications for catheterization included the inability to wean from ECMO (10 procedures) and cyanosis (10 procedures). Interventional procedures included angioplasty using stents (10 procedures, success rate of 90%), angioplasty using only balloons (2 procedures, success rate of 50%), and occlusion for residual shunts (8 procedures, success rate of 100%). No mortality was recorded during any procedure. Vasoactive–inotropic score had significantly decreased 48 h after catheterization when compared to pre-catheterization scores (p = 0.0001). Moreover, 72% of patients connected to ECMO support were successfully weaned from ECMO after catheterization. Procedural complications were recorded in 3 interventional procedures. Survival to hospital discharge was 55.5% and overall survival was 52%. Patients on ECMO support had a higher mortality than other patients.ConclusionCardiac catheterization can be performed safely in the early post-operative period, and it could improve the outcome of the patient (depending on the complexity of the cardiac lesions involved).
Highlights
Cardiac catheterization after congenital heart surgery may play an important role in the diagnosis and management of patients with a complicated or unusual post-operative course
As residual lesions after congenital heart surgery might carry a high risk for poor outcome, cardiac catheterization could provide a detailed evaluation of residual lesions and helps ensure that a proper decision was made for either further intervention during the same catheterization procedure or referral for redo surgery [7,8,9]
Out of 30 procedures, six procedures were performed for six patients immediately after surgery (3 interventional and 3 diagnostic), 12 more procedures were performed in the 1st week post-surgery (5 diagnostics, 7 interventions), and 2 procedures were performed in the 2nd week post-surgery
Summary
Cardiac catheterization after congenital heart surgery may play an important role in the diagnosis and management of patients with a complicated or unusual post-operative course. The main objective of this study was to evaluate the safety, efficacy, and outcome of cardiac catheterization performed in the early post-operative period following congenital heart surgery. As residual lesions after congenital heart surgery might carry a high risk for poor outcome, cardiac catheterization could provide a detailed evaluation of residual lesions and helps ensure that a proper decision was made for either further intervention during the same catheterization procedure or referral for redo surgery [7,8,9]. The aim of this study was to evaluate the safety, efficacy, and outcome of cardiac catheterization performed in the post-operative period (mostly on an emergency basis) and during the same admission after surgery Data and experience in this field are growing [10,11,12,13].
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