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Complications and mortality associated with cardiac catheterization in infants under one year: a prospective study
Insights
Cardiac catheterization (CC) in infants under one year has low complication rates, especially in older infants. Risk assessment before CC can predict major complications and mortality in high-risk cases.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Neonatal Health
Background:
- Cardiac catheterization (CC) is a common procedure for diagnosing and treating congenital heart defects in infants.
- Assessing the risks and outcomes of CC in this vulnerable population is crucial for clinical decision-making.
Purpose of the Study:
- To prospectively evaluate the incidence of complications and mortality following cardiac catheterization in patients under one year of age.
- To identify predictors of complications and mortality based on patient age and pre-procedural risk assessment.
Main Methods:
- Prospective examination of 312 cardiac catheterizations (CC) in 273 infants (<1 year) over a one-year period.
- Categorization of patients by age (<4 months vs. 4-12 months) and pre-CC risk assessment (high, medium, low risk).
- Analysis of complication rates, mortality at 24 hours, 48 hours, and one week, and attribution of deaths to CC complications.
Main Results:
- The incidence of complications requiring treatment was significantly higher in infants <4 months (12%) compared to those 4-12 months (1.5%).
- Major complications occurred more frequently in high-risk (30%) and medium-risk (14%) patients than in low-risk (4%) patients.
- Overall mortality rates at 24h, 48h, and 1 week were 3.8%, 8.3%, and 13.5%, respectively; however, deaths directly attributed to CC complications were very low (≤0.3%).
Conclusions:
- Age and pre-procedural risk assessment are significant factors in predicting complications following pediatric cardiac catheterization.
- The incidence of death directly from CC complications in infants is extremely low.
- CC is a relatively safe procedure in patients under one year, with mortality more often related to the underlying cardiac condition or subsequent surgery.
Abstract:
To evaluate complications and mortality following cardiac catheterization (CC) in patients under one year of age, we prospectively examined 312 CC on 273 patients from the centers in the New England Regional Infant Cardiac Program during a one-year period. Among CC performed on patients less than four months old, the incidence of complications requiring treatment was 12%; for patients 4-12 months, it was 1.5% (p less than 0.02). By pre-CC risk assessment, 13% of CC were high risk, 21% medium risk, and 66% low risk. The incidence of major complications was much greater among the High Risk (30%) compared with Medium Risk (14%) (p less than 0.05) and with Low Risk (4%) (p less than 0.001). The overall mortality rates 24 h, 48 h, and one week after CC were 3.8%, 8.3%, and 13.5%, including patients with inoperable lesions and those having cardiac surgery, while deaths directly attributable to a CC complication were 0, 0.3%, and 0.3%, respectively. We can predict, prior to CC, the high-risk cases where major complications and death are likeliest to occur. The incidence of death from CC-related complications is extremely low in patients under one year of age, compared with death from the underlying lesion or following cardiac surgery.