Right Heart Catheterization in Pediatric Pulmonary Arterial Hypertension: Insights and Outcome from a Large Tertiary Center

Xu, Zhuoyuan; Zhang, Hongsheng; Arvanitaki, Alexandra; Zhang, Chen; Li, Qiangqiang; Keller, Bradley B.; Gu, Heng

doi:10.3390/jcm11185374

Cited by 1 publication

(18 citation statements)

References 27 publications

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“…In general, this approach appears safe, with serious adverse event rates similar to previous reports. [6][7][8][9][10][11]15,[20][21][22][23]36 However, limitations of this report are noteworthy, particularly its retrospective nature and small sample size. Thus, conclusions regarding differences in hemodynamics and outcomes associated with the choice of an invasive versus noninvasive airway cannot be made or insinuated.…”

Section: Discussionmentioning

confidence: 87%

“…In fact, the maintenance of a noninvasive airway in >70% of procedures represents one of the highest rates reported to date. 8,11,15,17,24,25 This is despite a high-risk cohort with ~one-third age under 1 year and greater than 50% requiring some baseline respiratory support. In addition, we identify characteristics associated with the need for conversion to an invasive airway, which may guide airway management.…”

Section: Discussionmentioning

confidence: 99%

“…17,40 For example, acute pulmonary hypertensive episodes have been reported with induction and endotracheal intubation. 15,19,41,42 Conversely, the lack of having a controlled airway in the setting of acute decompensation is a potential important safety issue related to using a noninvasive airway. In some reports, anesthesia with the use of invasive airways has been shown to be a risk factor for adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9] The reported risk of serious adverse events during cardiac catheterization for pediatric pulmonary hypertension (PH) patients is variable, ranging from 2% to 6%. [6][7][8][9][10][11][15][16][17][18][19][20][21][22][23] Identified risk factors during cardiac catheterization include younger age, longer duration of procedure, suprasystemic pulmonary arterial pressures, right ventricular dysfunction, advanced functional class (III/IV), and treatment naiveté. [6][7][8][9][10][11][15][16][17][18][19][20][21]23 However, the type of anesthesia or respiratory support utilized has not been clearly identified as a risk factor.…”

Section: Introductionmentioning

confidence: 99%

“…In addition to obtaining direct pressure measurements, catheterization facilitates the determination of cardiac output, vascular resistances, vascular reactivity, and the ability to perform interventional procedures. 1,[6][7][8][9][10][11][12][13][14][15] Despite these advantages, the need for anesthesia or sedation adds an additional layer of complexity to the choice to proceed with cardiac catheterization in pediatric patients. [6][7][8][9] The reported risk of serious adverse events during cardiac catheterization for pediatric pulmonary hypertension (PH) patients is variable, ranging from 2% to 6%.…”

Section: Introductionmentioning

confidence: 99%

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A single institution anesthetic experience with catheterization of pediatric pulmonary hypertension patients

Morell,

Colglazier,

Becerra

et al. 2024

Pulm. circ.

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Cardiac catheterization remains the gold standard for the diagnosis and management of pediatric pulmonary hypertension (PH). There is lack of consensus regarding optimal anesthetic and airway regimen. This retrospective study describes the anesthetic/airway experience of our single center cohort of pediatric PH patients undergoing catheterization, in which obtaining hemodynamic data during spontaneous breathing is preferential. A total of 448 catheterizations were performed in 232 patients. Of the 379 cases that began with a natural airway, 274 (72%) completed the procedure without an invasive airway, 90 (24%) received a planned invasive airway, and 15 (4%) required an unplanned invasive airway. Median age was 3.4 years (interquartile range [IQR] 0.7–9.7); the majority were either Nice Classification Group 1 (48%) or Group 3 (42%). Vasoactive medications and cardiopulmonary resuscitation were required in 14 (3.7%) and eight (2.1%) cases, respectively; there was one death. Characteristics associated with use of an invasive airway included age <1 year, Group 3, congenital heart disease, trisomy 21, prematurity, bronchopulmonary dysplasia, WHO functional class III/IV, no PH therapy at time of case, preoperative respiratory support, and having had an intervention (p < 0.05). A composite predictor of age <1 year, Group 3, prematurity, and any preoperative respiratory support was significantly associated with unplanned airway escalation (26.7% vs. 6.9%, odds ratio: 4.9, confidence interval: 1.4–17.0). This approach appears safe, with serious adverse event rates similar to previous reports despite the predominant use of natural airways. However, research is needed to further investigate the optimal anesthetic regimen and respiratory support for pediatric PH patients undergoing cardiac catheterization.

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