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Complications associated with pediatric cardiac catheterization
R Vitiello1, B W McCrindle, D Nykanen
1Department of Pediatrics, The University of Toronto School of Medicine, The Hospital for Sick Children, Ontario, Canada.
Insights
Pediatric cardiac catheterizations carry risks, with 8.8% of procedures causing complications. Young age and interventional procedures increase the risk of adverse events and mortality in children.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- The pediatric catheterization laboratory has expanded its role beyond diagnosis to include therapeutic interventions.
- Despite advancements, cardiac catheterization remains crucial for diagnosing congenital heart defects and hemodynamic abnormalities.
Purpose of the Study:
- To assess the relative risks associated with pediatric diagnostic, interventional, and electrophysiologic catheterizations.
- To identify independent risk factors contributing to complications in pediatric cardiac catheterization procedures.
Main Methods:
- A retrospective analysis of 4,952 consecutive pediatric catheterization procedures.
- Classification of complications into major and minor categories, with specific attention to vascular and arrhythmic events.
Main Results:
- Overall complication rate was 8.8% (436/4952), with vascular complications (3.8%) being most frequent.
- Major complications occurred in 102 cases, with arrhythmias being the most common (24 cases).
- Mortality directly related to the procedure was 0.14% (7/4952), predominantly in infants; young patient age and interventional procedures were identified as independent risk factors.
Conclusions:
- Pediatric cardiac catheterization is associated with ongoing risks, necessitating improvements in equipment and vascular access techniques.
- Young patient age and the performance of interventional procedures are significant risk factors for morbidity and mortality.
- Future research should focus on developing more flexible and smaller equipment and exploring alternative vascular access methods to mitigate risks.
Objectives:
The aim of this study was to determine the relative risks of pediatric diagnostic, interventional and electrophysiologic catheterizations.
Background:
The role of the pediatric catheterization laboratory has evolved in the last decade as a therapeutic modality, although remaining an important tool for anatomic and hemodynamic diagnosis.
Methods:
A study of 4,952 consecutive pediatric catheterization procedures was undertaken.
Results:
Patient ages ranged from 1 day to 20 years (median 2.9 years). One or more complications occurred in 436 studies (8.8%) and were classified as major in 102 and minor in 458, with vascular complications (n=189; 3.8% of procedures) the most common adverse event. Arrhythmic complications (n=24) were the most common major complication. Death occurred in seven cases (0.14%) as a direct complication of the procedure and was more common in infants (n=5). Independent risk factors for complications included a young patient age and undergoing an interventional procedure.
Conclusions:
Complications continue to be associated with pediatric cardiac catheterization. Efforts should be directed to improving equipment for flexibility and size, and finding alternative methods for vascular access. Patient age and interventional studies are risk factors for morbidity and mortality.