Programmatic Approach to Outpatient Cardiac Catheterization in Children With Stable Pulmonary Arterial Hypertension.

Area of Science:

• Pediatric Cardiology
• Pulmonary Hypertension Research
• Medical Procedure Optimization

Background:

• Pediatric pulmonary arterial hypertension (PH) management often requires cardiac catheterization.
• Outpatient cardiac catheterization presents unique challenges for same-day discharge in pediatric PH patients.
• Optimizing procedural safety and efficiency is crucial for enabling early discharge.

Purpose of the Study:

• To evaluate the safety and feasibility of same-day discharge after cardiac catheterization in pediatric outpatients with PH.
• To identify clinical characteristics influencing the safety of this approach.
• To describe the outcomes of a strategy prioritizing spontaneous ventilation and procedural brevity.

Main Methods:

• Retrospective cohort study of pediatric outpatients (<21 years) undergoing cardiac catheterization for PH (2009-2018).
• Data collected included demographics, clinical status, and procedural details.
• Mixed effects logistic regression used to model factors associated with admission, accounting for repeated measures.

Main Results:

• Of 250 procedures in 118 outpatients, 74% were discharged same-day with no major adverse events within 48 hours.
• Median procedural duration was 51 minutes.
• Endotracheal intubation, younger age, longer procedures, and poorer functional status were linked to higher admission rates.

Conclusions:

• Outpatient pediatric cardiac catheterization for PH can be safely performed with a focus on spontaneous ventilation and procedural efficiency.
• Most patients, particularly older children not requiring intubation, are candidates for same-day discharge or low-acuity observation.
• This approach enhances patient throughput and potentially reduces healthcare costs.