Incidence, Predictors, and Outcomes of Cardiac Perforation During Pediatric Cardiac Catheterization: a Retrospective
B A McCrossan1,2, S Karayiannis3, M Shields4
1Dept of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE, Northern Ireland, UK. brianmccrossan@doctors.org.uk.
Insights
Cardiac perforation during pediatric cardiac catheterization is rare but life-threatening. Younger, smaller patients and specific procedures increase risk, leading to higher mortality and complications.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Patient Safety
Background:
- Cardiac perforation is a rare but severe complication of cardiac catheterization.
- Limited data exists on risk factors and outcomes in children.
Purpose of the Study:
- To determine the incidence, risk factors, and outcomes of cardiac perforation in children undergoing cardiac catheterization.
- To identify predictors of cardiac perforation in this pediatric population.
Main Methods:
- Retrospective analysis of the Congenital Cardiovascular Interventional Study Consortium registry.
- Inclusion of patients aged <18 years over a 9-year period (2009-2017).
- Primary outcomes: incidence, risk factors, and outcomes of cardiac perforation.
Main Results:
- Cardiac perforation occurred in 0.14% of 36,986 procedures.
- Younger, smaller patients and urgent/interventional procedures were associated with higher risk.
- Predictors included higher CRISP score, younger age, and radiofrequency pulmonary valve perforation.
- Associated with 14% mortality, 42% need for emergency procedures, 14% ECMO, and 6% cardiac arrest.
Conclusions:
- Cardiac perforation is a serious complication with significant secondary issues.
- Higher CRISP score, younger age, and radiofrequency pulmonary valve perforation are key predictors.
Introduction:
Cardiac perforation is a rare life-threatening complication of cardiac catheterization. There is very little published literature detailing risk factors for cardiac perforation and outcomes from this complication in children.
Materials And Methods:
This was a retrospective study analyzing the cardiac catheterization case registry of the Congenital Cardiovascular Interventional Study Consortium. Children aged < 18 years were included during the study period of 9 years (January 2009-December 2017). The primary outcome measures were incidence of cardiac perforation, risk factors for and outcomes of patients who experience cardiac perforation during cardiac catheterization.
Results:
Cardiac perforation occurred in 50 patients from a total of 36,986 (0.14%). Cardiac perforation was more likely to occur in younger, smaller patients undergoing urgent/emergent and interventional procedures (p < 0.01). Cardiac peroration risk was significantly different across diagnostic and procedure categories (p < 0.01). Higher CRISP score (Area Under Curve [AUC] = 0.87), lower age, and procedure category (radiofrequency perforation of pulmonary valve, AUC = 0.84) were independent predictors of cardiac perforation. Cardiac perforation was associated with a significantly higher rate of mortality (14%), further emergency procedure (42%), ECMO (14%), and cardiac arrest (6%), p < 0.01.
Conclusions:
Cardiac perforation during cardiac catheterization is a life-threatening complication with a range of associated secondary complications. Higher CRISP score, lower age, and radiofrequency perforation of pulmonary valve are independent predictors.
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