Interventional catheterization performed in the early postoperative period after congenital heart surgery in children.
OBJECTIVE
The purpose of this study was to examine the safety and efficacy of interventional catheterization performed early after congenital heart surgery.


BACKGROUND
Transcatheter interventions performed in the early postoperative period are viewed as high risk. To date, there have been limited published data regarding these procedures.


METHODS
All catheterizations performed within six weeks after congenital heart surgery between August 1995 and January 2001 were retrospectively reviewed. A cardiac anesthesiologist, cardiac intensivist, cardiac surgeon, and operating room team were available for all cases. Interventional procedures were performed based on clinical indications, regardless of the time elapsed from surgery.


RESULTS
Sixty-two patients, median age four months (2 days to 11 years), weight 4.7 kg (2.3 to 45 kg), underwent 66 catheterizations on median postoperative day 9 (0 to 42 days). Thirty-five cases involved 50 interventional procedures. Nine patients required extracorporeal cardiopulmonary support. Success rates by procedure were: angioplasty, 100%; stent implantation, 87%; vascular/septal occlusion, 100%; and palliative pulmonary valvotomy, 75%. Complications included stent migration (one patient), cerebral vascular injury (one patient), and left pulmonary artery stenosis (one patient). Thirty procedures involved angioplasty or stent implantation, including 26 involving a recently created suture line. Suture disruption or trans-mural vascular tears were not observed. There was no procedural mortality. Thirty-day survival for patients undergoing intervention was 83%.


CONCLUSIONS
Transcatheter interventions can be successfully performed in the early postoperative period. These procedures can have a positive impact on patient outcome; however, they should be performed only by a pediatric interventional cardiologist supported by a multi-disciplinary team.
Zahn
Evan M
EM
Department of Cardiology, Miami Children's Hospital, Miami, Florida 33155, USA. evan.zahn@mch.com
Dobrolet
Nancy C
NC
Nykanen
David G
DG
Ojito
Jorge
J
Hannan
Robert L
RL
Burke
Redmond P
RP
D000800:Angioplasty, Balloon; D019917:Blood Vessel Prosthesis Implantation; D006328:Cardiac Catheterization; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D005548:Foreign-Body Migration / Q000209:etiology; D006330:Heart Defects, Congenital / Q000401:mortality / Q000628:therapy*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D011184:Postoperative Period; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery; D018633:Pulmonary Atresia / Q000401:mortality / Q000628:therapy; D011652:Pulmonary Circulation / Q000502:physiology; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome