Complications of cardiac catheterization in children with congenital heart disease

Abstract

Tokel K, Gümüş A, Ayabakan C, Varan B, Erdoğan İ. Complications of cardiac catheterization in children with congenital heart disease. Turk J Pediatr 2018; 60: 675-683.Catheterization procedures for congenital heart disease include a broad range of procedures with a large spectrum of potential adverse outcomes. We aimed to determine the incidence of various complications during pediatric cardiac catheterizations and to designate the relative risk factors for such complications.All pediatric patients undergoing cardiac catheterizations between January 2005-December 2010 were included. Data are collected prospectively by filling out computerized catheterization reports. Patient records were scanned for potential risk factors retrospectively. Groups were divided based on cardiac diagnosis; type of procedure. Adverse events were categorized into major or minor events. A total of 2662 cardiac catheterizations were performed during this period. The mean age of patients was 53.2±64.3 months. Diagnostic catheterizations were done for 1797 (67.5%) patients, and interventional procedures were done in 865 (32.5%) cases. Adverse events were observed in 688 patients (26%) during 941 procedures. Minor and major events were seen in 21.4% and 7.1% of the procedures respectively. Most frequent major complications were anesthesia related (6%), most frequent minor complications were vascular complications (45.2%). Complications were more frequent in younger patients (p=0.0001), during interventional procedures (p=0.0001). Thirteen patients died after a cardiac catheterization; they were younger and had longer procedures compared to those who survived (p=0.0001). Vascular complications were frequent among younger patients, with prolonged procedure time and vessel access (p<0.0001). Cyanotic patients had more complications (p<0.05; OR for major and minor complications: 3.5 and 2 respectively). Minor complications were 2.7 times more likely in ventricular outflow obstructions (p<0.05).The complication rates of cardiac catheterization in children are low, but not negligible. Defining risk factors will help anticipate adverse events, which will guide in preparation for rescue procedures and improvement of patient safety systems in catheterization laboratories.

Frequency and risk factors of acute and permanent femoral arterial occlusion in neonates with congenital heart disease who undergo ultrasound˗guided femoral arterial access

“…We obtained a shorter time in terms of arterial access time compared to those of studies that used traditional technique and US-GFAA. 2,5,7,13,15,20 Although a study reported that long access time increases the complications of the access site, 13 our study did not identify arterial access time as a risk factor in patients with ALAP and PFAO.…”

“…7,19 Several studies have reported that prolonged cannulation time increases arterial occlusion and access site complications. 13,17,18 In our cohort , the cannulation time in was significantly shorter than in previous studies. 7,13,15 The cannulation time was statistically longer in patients with ALAP than in those without ALAP.…”

“…13,17,18 In our cohort , the cannulation time in was significantly shorter than in previous studies. 7,13,15 The cannulation time was statistically longer in patients with ALAP than in those without ALAP. No significant difference was found between patients with and those without PFAO.…”

“…After the sheath was placed, we administered intravenous unfractionated heparin 100 U/kg to patients whose < INR 2, and an additional dose of 50U/kg was administered to patients whose cannulation time was longer than 1 h, as described in previous studies. 7,13,14 Catheters and sheaths were flushed with heparinised saline before use. When ALAP was considered in the cannulated leg, treatment was initiated according to a predefined protocol.…”

“…7 Due to the nature of newborn patients, they have risk factors including small age, low body weight, and <3 mm femoral arterial diameter, which are the most important risk factor for femoral artery occlusion. 7,13,16 If we had included patients older than 1 month of age in our study and made a comparison, small age and low body weight could be significant risk factors for ALAP and PFAO. Therefore, we found that body weight, age, and gestational age were similar between groups, and did not identify them as risk factors for ALAP and PFAO.…”