Safety of Cardiac Catheterization at a Center Specializing in the Care of Patients with Pulmonary Arterial Hypertension

Abstract

Cardiac catheterization is important for the management of patients with pulmonary arterial hypertension (PAH). It is used for diagnosis, assessment, and monitoring of PAH patients, as well as to perform interventions such as balloon atrial septostomy and coil embolization of collateral vessels. Although reports on the risks of catheterization in PAH patients are scarce, many centers hesitate to perform these procedures in such fragile patients. We performed a retrospective chart review of all cardiac catheterizations performed in PAH patients over 10 years at our pulmonary hypertension center. Demographic, hemodynamic, and outcome data were collected. Complication rates were determined, and multivariate proportional hazards modeling was performed to identify predictors of catheterization-related complications. There were 1,637 catheterizations performed in 607 patients over 10 years. Pediatric patients accounted for 50% of these cases, 48% were performed in patients with idiopathic PAH, and 49% were performed under general anesthesia. While the overall complication rate was 5.7%, the rate of major complications was only 1.2% (n = 20). Although there were 8 deaths during the admission following catheterization, only 4 of these were related to the procedure, yielding a catheterization-related mortality of 0.2%. In conclusion, when performed at a pulmonary hypertension center with expertise in the care of PAH patients, cardiac catheterization is associated with low complication rates and mortality, and it should remain an important tool in the management of these patients.

Pediatric Pulmonary Hypertension

“…Catheterizations should be performed by pediatric catheterization teams experienced in PH to reduce related morbidity or mortality and to improve the quality of comprehensive studies. 77 In general, the study should include AVT (see below). Additionally, one should consider performing repeat cardiac catheterization in the setting of clinical worsening, 3 to 12 months after a significant change in therapy, or every 1 to 2 years during follow-up.…”

Preventative effects of prostaglandin E1 in combination with iodized olive oil on liver fibrosis after transcatheter arterial chemoembolization in a rabbit model of CCl4-induced liver fibrosis

“…As reported, femoral cannulation is relatively simple, and with a high success rate, so it is suitable for the infusion of drugs through the hepatic artery (Zuckerman et al 2013). Further, the surgery caused little trauma to the vascular system and the liver, and maintained the integrity of the vascular anatomy and the movement of blood in liver.…”

Desenlaces críticos en pacientes pediátricos con hipertensión pulmonar y cardiopatía congénita llevados a cateterismo cardíaco diagnóstico en el Hospital Cardiovascular de Soacha entre 2013 y 2016

“…Un estudio observacional realizado en el hospital de la Universidad de Columbia Medical Center reportó complicaciones mayores (arritmias y trauma vascular) en el 1.2% de los pacientes con una mortalidad de 0.2% para cateterismo cardíaco asociado a hipertensión pulmonar con y sin anomalía congénita asociada (6). El presente trabajo contribuye al conocimiento en torno a la presentación de desenlaces críticos para el cateterismo, con un énfasis especial en el punto de vista anestésico.…”