Cardiac catheterization addressing early post-operative complications in congenital heart surgery—a single-center experience

Abstract

Background Cardiac catheterization after congenital heart surgery may play an important role in the diagnosis and management of patients with a complicated or unusual post-operative course. The main objective of this study was to evaluate the safety, efficacy, and outcome of cardiac catheterization performed in the early post-operative period following congenital heart surgery. All patients who underwent cardiac catheterization after congenital heart surgery during the same admission of cardiac surgery from November 2015 to May 2018 were included in the study. Results Thirty procedures were performed for 27 patients (20 interventional and 10 diagnostic). The median age of the patients was 15 months (15 days to 20 years), median weight was 8.2 kg (3.4 to 53 kg), and median time from surgery was 3 days (0–32 days). Eleven procedures were performed for 11 patients on extracorporeal membrane oxygenation (ECMO) support. The main indications for catheterization included the inability to wean from ECMO (10 procedures) and cyanosis (10 procedures). Interventional procedures included angioplasty using stents (10 procedures, success rate of 90%), angioplasty using only balloons (2 procedures, success rate of 50%), and occlusion for residual shunts (8 procedures, success rate of 100%). No mortality was recorded during any procedure. Vasoactive–inotropic score had significantly decreased 48 h after catheterization when compared to pre-catheterization scores (p = 0.0001). Moreover, 72% of patients connected to ECMO support were successfully weaned from ECMO after catheterization. Procedural complications were recorded in 3 interventional procedures. Survival to hospital discharge was 55.5% and overall survival was 52%. Patients on ECMO support had a higher mortality than other patients. Conclusion Cardiac catheterization can be performed safely in the early post-operative period, and it could improve the outcome of the patient (depending on the complexity of the cardiac lesions involved).

Early Cardiac Catheterizations within 30 Days Post Congenital Heart Surgery in Children

“…Therefore, CCs during the early postoperative period are often avoided or postponed. Nevertheless, unsatisfying outcomes after congenital heart surgery will in some cases necessitate re-operations or transcatheter interventions in the immediate postoperative period [1][2][3][4][5][6][7][8][9]. Yet, early cardiac transcatheter interventions may be the safest procedural option, especially in critically ill children in whom re-operations on cardiopulmonary bypass in quick succession are deemed to be of even greater risk [6][7][8][9].…”

“…Nevertheless, unsatisfying outcomes after congenital heart surgery will in some cases necessitate re-operations or transcatheter interventions in the immediate postoperative period [1][2][3][4][5][6][7][8][9]. Yet, early cardiac transcatheter interventions may be the safest procedural option, especially in critically ill children in whom re-operations on cardiopulmonary bypass in quick succession are deemed to be of even greater risk [6][7][8][9]. Considering the limited data available in the literature [1][2][3][4][5][6][7][8][9], we propose to evaluate indications, feasibility, safety, and outcome of early CC within 30 days after CHS in children at our institution over an 11-year period.…”

“…Yet, early cardiac transcatheter interventions may be the safest procedural option, especially in critically ill children in whom re-operations on cardiopulmonary bypass in quick succession are deemed to be of even greater risk [6][7][8][9]. Considering the limited data available in the literature [1][2][3][4][5][6][7][8][9], we propose to evaluate indications, feasibility, safety, and outcome of early CC within 30 days after CHS in children at our institution over an 11-year period. During the assessed period (from 2010 to 2020), the interventional lead and team of the CC laboratory with its standards, know-how, and technical options remained unchanged.…”

Balloon angioplasty and stent implantation within 30 days postcongenital heart surgery (CHS) in children

“…There is limited experience reported in literature for cardiac catheterization (CC) therapy, especially balloon angioplasty (BAP) and stent implantation (SI) procedures, in the early postoperative period after congenital heart surgery (CHS) in children 1–10 . Generally, these interventions are considered potential high‐risk procedures associated with an elevated rate of morbidity and mortality 2–4 .…”

Impact of Cardiac Catheterization on the Outcome of Extracorporeal Membrane Oxygenation (ECMO) After Congenital Cardiac Surgery - Two Centers Experience

“…Although the outcome of cardiac patients connected to ECMO support has been markedly improved, still more than 25% of these patients might have a failure of weaning from ECMO support [1,2,5,6]. After congenital heart surgery, end-organ damage, signi cant cardiac dysfunction and signi cant residual cardiac lesions were known as undesirable risk factors that preclude successful weaning from ECMO and survival [7][8][9].…”