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[Complications of two series of 1000 each heart catheterization studies in childhood]
Insights
Cardiac catheterization complications in pediatric patients significantly decreased, especially in neonates, due to improved techniques and experience. This study highlights advancements in pediatric cardiac procedures and patient safety.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Medical Device Safety
Context:
- Cardiac catheterization is a vital diagnostic and therapeutic tool in pediatric patients.
- Assessing and minimizing catheter-induced complications is crucial for patient outcomes.
- Previous studies have documented various complications associated with pediatric cardiac catheterization.
Purpose:
- To prospectively investigate and compare catheter-induced complications in two series of pediatric cardiac catheterizations.
- To identify factors contributing to the reduction of complications over time.
- To analyze complication rates across different pediatric age groups, particularly neonates.
Summary:
- A prospective study of 2,000 pediatric cardiac catheterizations (two series of 1,000) analyzed complications including arrhythmias, vascular issues, perforations, CNS events, clinical deterioration, and mortality.
- Significant reductions were observed in arrhythmias (7.6% to 5.0%), vascular complications (2.1% to 1.4%), clinical deterioration (2.6% to 0.6%), CNS complications (0.4% to 0.1%), and mortality (2.0% to 0.7%).
- Neonates demonstrated the most substantial improvement in serious complications and mortality. Factors contributing to these improvements include increased investigator experience, use of echocardiography, percutaneous techniques, prostaglandins, and enhanced anesthesia/intubation protocols.
Impact:
- Demonstrates a significant improvement in the safety profile of pediatric cardiac catheterization over time.
- Highlights the critical role of procedural advancements and enhanced care in reducing complications, particularly in high-risk neonates.
- Identifies persistent challenges in neonates and cyanotic patients, guiding future research and clinical focus for improved pediatric cardiac interventions.
Abstract:
Two series of 1,000 consecutive cardiac catheterizations in neonates, infants and older children were prospectively investigated with respect to catheter-induced complications. These were categorized into arrhythmias, vascular complications, catheter and contrast perforations, central nervous (CNS) complications, clinical deterioration and catheter-related death. Comparing series 1 and 2, the number of arrhythmias decreased from 7.6% to 5.0%, acute vascular complications decreased from 2.1% to 1.4%, the number of patients showing clinical deterioration from 2.6% to 0.6% and CNS complications from 0.4% to 0.1%, whereas catheter or contrast perforations-remained virtually constant at 0.4% and 0.5% respectively. Catheter-induced mortality decreased from 2.0% to 0.7%. The group of neonates showed the greatest reduction in serious complications and catheter-induced mortality (31.3% to 12.4% and 11.0% to 4.4%, respectively). Increasing experience of the investigators, introduction of two-dimensional echocardiography as a supplementary investigation or even catheter substitute, use of percutaneous catheterization and sheath techniques, introduction of E-type prostaglandins and increased use of intubation and anaesthesia for catheterization all played an important role in the improvement shown in this investigation. Complications are still mainly seen in the group of neonates and cyanotic patients.