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

When performing cardiac catheterization in pediatric outpatients with pulmonary arterial hypertension (PH), our approach is to allow spontaneous ventilation, minimize procedural length, and evaluate for same-day discharge whenever safe and feasible. We describe our experience with this approach and identify clinical characteristics that influenced procedural safety. Outpatients < 21 years who underwent catheterization for PH from 2009 to 2018 were included in the retrospective cohort. Demographic, clinical, and procedural data were collected. Data were modeled using a mixed effects logistic regression for correlated data, and a patient random effect was included to account for multiple procedures in the same patient. Of 409 catheterizations screened, 250 procedures in 118 outpatients were included. Of the 250 procedures, 185 (74.0%) were discharged on the same day. There were no major adverse events within 48 h of discharge in any of the 185 nor in the 12 (197 total, 78.8%) admitted for medication titration or an unrelated procedure (i.e., could have otherwise been discharged). Median procedural duration was 51.0 (33.0, 76.8) minutes. Endotracheal intubation, younger age, longer procedural duration, and worse functional status were associated with higher odds of admission. In a prospective secondary cohort of 39 procedures in 34 patients, 32 (82%) were discharged same-day without complication, including over 90% of children over 3 years of age who were managed without endotracheal intubation. By prioritizing spontaneous ventilation and procedural efficiency, outpatient pediatric PH patients who undergo catheterization, emergence, and a 4-h observation with no complications may be considered for same-day discharge or observation in a low-acuity bed.