Risk Factors for Major Early Adverse Events Related to Cardiac Catheterization in Children and Young Adults With Pulmonary Hypertension: An Analysis of Data From the IMPACT (Improving Adult and Congenital Treatment) Registry

Abstract

BackgroundCardiac catheterization is the gold standard for assessment and follow‐up of patients with pulmonary hypertension (PH). To date, there are limited data about the factors that influence the risk of catastrophic adverse events after catheterization in this population.Methods and ResultsA retrospective multicenter cohort study was performed to measure risk of catastrophic adverse outcomes after catheterization in children and young adults with PH and identify risk factors for these outcomes. All catheterizations in children and young adults, aged 0 to 21 years, with PH at hospitals submitting data to the IMPACT (Improving Adult and Congenital Treatment) registry between January 1, 2011, and December 31, 2015, were studied. Using mixed‐effects multivariable regression, we assessed the association between prespecified subject‐, procedure‐, and center‐level covariates and the risk of death, cardiac arrest, or mechanical circulatory support during or after cardiac catheterization. A total of 8111 procedures performed in 7729 subjects at 77 centers were studied. The observed risk of the composite outcome was 1.4%, and the risk of death before discharge was 5.2%. Catheterization in prematurely born neonates and nonpremature infants was associated with increased risk of catastrophic adverse event, as was precatheterization treatment with inotropes and lower systemic arterial saturation. Secondary analyses demonstrated the following: (1) increasing volumes of catheterization in patients with PH were associated with reduced risk of composite outcome (odds ratio, 0.8 per 10 procedures; P=0.002) and (2) increasing pulmonary vascular resistance and pulmonary artery pressures were associated with increased risk (P<0.0001 for both).ConclusionsYoung patients with PH are a high‐risk population for diagnostic and interventional cardiac catheterization. Hospital experience with PH is associated with reduced risk, independent of total catheterization case volume.

Relationship between pulmonary artery acceleration time and pulmonary artery pressures in infants

“…Elevated right ventricular (RV) pressure can lead to RV failure, which is usually a lifelong disease and may result in death . Pulmonary hemodynamic assessment in the newborn poses unique problems due to technical challenges and risk of complications . Cardiac catheterization is regarded as the gold standard diagnostic test to directly measure pulmonary arterial pressure (PAP), calculate pulmonary vascular resistance (PVR), and study pulmonary vascular reactivity to therapy…”

“…3 Pulmonary hemodynamic assessment in the newborn poses unique problems due to technical challenges and risk of complications. 4,5 Cardiac catheterization is regarded as the gold standard diagnostic test to directly measure pulmonary arterial pressure (PAP), calculate pulmonary vascular resistance (PVR), and study pulmonary vascular reactivity to therapy. 6 Echocardiography is a noninvasive method commonly used to estimate PAP.…”

Noninvasive Bedside Vasodilator Testing Using Echocardiography

“…The risk for mortality and morbidity during cardiac catheterization is known to be higher in children with PH, with risks reported at 1.2% and 5.7%, respectively. 5 , 6 Children younger than 2 years and those requiring general anesthesia have a higher risk for catheterization-associated complications. 5 The risk for cardiac catheterization may be higher in the postoperative period, though there is scant evidence in the pediatric PH population.…”

Pediatric and Adolescent Pulmonary Hypertension: What Is the Risk of Undergoing Invasive Hemodynamic Testing?

“…To more specifically estimate individual risk on the basis of PH severity, O'Byrne and colleagues, in this issue of Journal of the American Heart Association ( JAHA ) query the Improving Pediatric and Adult Congenital Treatment Registry to determine the risk of catastrophic AEs in children and adolescents with PH undergoing HC . A secondary analysis was undertaken to determine if PH disease severity affects individual AE risk and also to determine the degree to which hospital PH‐HC experience affects AE risk.…”