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Outcomes of emergency surgical intervention for complications in the cardiac catheterization laboratory
Anand Kumar Mishra1, Vidur Bansal1, Rohit Manoj Kumar2
1Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Emergency surgery is rarely needed after cardiac catheterization, but it is crucial for managing serious complications. Careful patient selection and pre-procedure heart team discussions can help mitigate risks and improve outcomes in these rare cases.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Cardiac catheterization is a common procedure with a low but significant complication rate.
- Complications from cardiac catheterization necessitate emergency surgical intervention in a small subset of patients.
- Understanding outcomes of emergency surgical management is vital for improving patient safety.
Purpose of the Study:
- To analyze the outcomes of patients requiring emergency surgical intervention due to complications during cardiac catheterization.
- To identify patient demographics and underlying cardiac conditions associated with these complications.
- To evaluate the mortality and management timelines for these critical events.
Main Methods:
- Retrospective analysis of patients undergoing emergency surgery for cardiac catheterization complications.
- Data collected from July 2017 to July 2022.
- Inclusion criteria focused on patients requiring immediate surgical management post-procedure.
Main Results:
- 0.1% (57/52,326) of patients required emergency surgery.
- Congenital heart disease (49.1%) was the most common underlying condition, followed by coronary artery disease (19.3%).
- Thirty-day mortality was 7%, with a mean delay of 8.3 hours from catheterization lab to operating room.
Conclusions:
- Despite advancements, cardiac catheterization complications requiring surgery can occur.
- Pre-operative Heart Team discussions are essential for managing potential surgical risks.
- Cardiologists should exercise caution in complex cases to minimize the need for emergency surgical intervention.
Background:
In today's era, cardiac catheterization procedures are becoming increasingly safe, but they are still fraught with complications. We aimed to study the outcomes of patients who underwent emergency surgical intervention for complications in the cardiac catheterization laboratory.
Methods:
A retrospective analysis of patients who required emergency surgical management following a complication in the cardiac catheterization laboratory in our institute from July 2017 to July 2022 was done.
Result:
A total of 57 patients out of a total of 52,326 patients (0.1%) were included. The average age of presentation was 10.4 years. Congenital heart disease (CHD) constituted the majority of the cases (28/57-49.1%), coronary artery disease (CAD) constituted 19.3% (11/57), and rheumatic heart disease (RHD) constituted 8.8% (5/57) of the cases. Apart from this, 22.80% patients (13/57) were grouped together in the miscellaneous group. In total, 76.9% (10/13) of these patients had pericardial effusion and they developed a right ventricular (RV) rent following an attempted pigtail drainage. Also, one patient each had a RV rent following an attempted permanent pacemaker implantation for heart block and an endocardial biopsy respectively. One patient had a left bronchial rupture following thoracic endovascular aortic repair (TEVAR) for descending thoracic aorta (DTA) aneurysm. Thirty-day mortality was 7% (4/57), and the mean time of shifting the patients from the catheterization laboratory to the operating room was 8.3 h.
Conclusion:
Cardiac catheterization procedures have become increasingly safe, but complications can still occur, for which the cardiac surgeon should be briefed in a Heart Team meeting before taking up such cases. Even though these complications form a small percentage, the cardiologist should exercise some caution in attempting cases which could have a relatively easier surgical correction.
