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Congenital Cardiac Catheterization Risk Assessment in Infants Under 2.5 kg.

Michael L O'Byrne1, Nicholas S Boscamp2, Kimberlee Gauvreau2

  • 1Division of Cardiology, the Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Pediatric Cardiology
|March 28, 2025
PubMed
Summary
This summary is machine-generated.

Congenital cardiac catheterization (CCC) in neonates under 2.5kg has risks that vary by procedure. Patent ductus arteriosus (PDA) closures had fewer adverse events than other procedures, emphasizing tailored risk assessment for these high-risk infants.

Keywords:
Adverse eventsCardiac catheterizationCongenital heart diseaseRisk-adjustmentSmall infants

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Area of Science:

  • Pediatric Cardiology
  • Interventional Cardiology
  • Neonatal Medicine

Background:

  • Premature and small-for-gestational-age neonates with congenital heart disease (CHD) increasingly require congenital cardiac catheterization (CCC).
  • Standard risk models do not fully capture the unique procedural and patient-specific risks in this vulnerable population.
  • Accurate risk stratification is crucial for optimizing outcomes in neonates undergoing CCC.

Purpose of the Study:

  • To assess the risks associated with congenital cardiac catheterization (CCC) in infants weighing less than 2.5 kg.
  • To stratify risks by procedural type, specifically comparing patent ductus arteriosus (PDA) closures with all other procedures.
  • To identify predictors of clinically meaningful adverse events (CMAE) in this high-risk neonatal group.

Main Methods:

  • Analysis of patient and procedural data from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry (2014-2022).
  • Inclusion of 1,345 cases of infants < 2.5 kg undergoing diagnostic or interventional catheterization.
  • Stratification into historical (2014-2018) and modern (2019-2022) eras, and by procedural category (PDA closure vs. 'All Other Cases').
  • Multivariable logistic regression used to assess associations between covariates and CMAE.

Main Results:

  • In the modern era, PDA closures (66.8% of cases) had a significantly lower CMAE rate (3.6%) compared to 'All Other Cases' (8.1%).
  • Among 'All Other Cases', interventional procedures (77%) had a slightly lower CMAE rate (6.4%) than diagnostic procedures (7.7%).
  • Specific CMAE varied by procedure type: PDA cases primarily experienced respiratory events, while 'All Other Cases' had more access complications and arrhythmias.

Conclusions:

  • Risk in neonates < 2.5 kg undergoing CCC is highly dependent on the specific procedure and patient factors.
  • The findings underscore the need for tailored risk assessment tools and individualized care plans for this population.
  • This study provides the largest dataset to date, highlighting strategies to improve outcomes in high-risk neonates undergoing cardiac catheterization.