Incidence and Management of Life-Threatening Adverse Events During Cardiac Catheterization for Congenital Heart Disease

C Huie Lin,Ralf Holzer,Julie A Vincent,John W Moore,Robert H Beekman,Sanjeet Hegde,Alejandro Torres,Kimberlee Gauvreau,Diego Porras,David T Balzer,Lisa Bergersen,Laurie Armsby,Audrey C Marshall

doi:10.1007/s00246-013-0752-y

Abstract

Continued advancements in congenital cardiac catheterization and interventions have resulted in increased patient and procedural complexity. Anticipation of life-threatening events and required rescue measures is a critical component to preprocedural preparation. We sought to determine the incidence and nature of life-threatening adverse events in congenital and pediatric cardiac catheterization, risk factors, and resources necessary to anticipate and manage events. Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site (range 133–3,802)]. The incidence of all life-threatening events was 2.1 % [95 % confidence interval (CI) 1.8–2.4 %], whereas mortality was 0.28 % (95 % CI 0.18–0.41 %). Fifty-seven life-threatening events required cardiopulmonary resuscitation, whereas 9 % required extracorporeal membrane oxygenation. Use of a risk adjustment model showed that age <1 year [odd ratio (OR) 1.9, 95 % CI 1.4–2.7, p < 0.001], hemodynamic vulnerability (OR 1.6, 95 % CI 1.1–2.3, p < 0.01), and procedure risk (category 3: OR 2.3, 95 % CI 1.3–4.1; category 4: OR 4.2, 95 % CI 2.4–7.4) were predictors of life-threatening events. Using this model, standardized life-threatening event ratios were calculated, thus showing that one institution had a life-threatening event rate greater than expected. Congenital cardiac catheterization and intervention can be performed safely with a low rate of life-threatening events and mortality; preprocedural evaluation of risk may optimize preparation of emergency rescue and bailout procedures. Risk predictors (age < 1, hemodynamic vulnerability, and procedure risk category) can enhance preprocedural patient risk stratification and planning.Electronic supplementary materialThe online version of this article (doi:10.1007/s00246-013-0752-y) contains supplementary material, which is available to authorized users.

Highlights

Significant advances in transcatheter technologies [1, 19] have increased the complexity and heterogeneity of congenital cardiac catheterization procedures as well as the complexity and pre-existing morbidity of patients undergoing catheterization
Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site]
We report a low incidence of life-threatening events (2.1 %) and mortality (0.28 %) despite the complexity of modern patients and procedures

Summary

Introduction

Significant advances in transcatheter technologies [1, 19] have increased the complexity and heterogeneity of congenital cardiac catheterization procedures as well as the complexity and pre-existing morbidity of patients undergoing catheterization. Previous studies of pediatric cardiac catheterization reported rates of major complications of 0.9–6 % and mortality of 0.14–0.7 %; these reports originated from single-center retrospective studies with heterogeneous case mixes and data predating technological advances of the current era [9, 17, 18]. Work from this group has previously shown the overall rate of life-threatening adverse events during congenital and pediatric cardiac catheterization and predictors of these events [4]. The previously developed Catheterization for Congenital Heart Disease Adjustment for Risk Method (CHARM) was applied to report standardized life-threatening event ratios by institution

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