Outcomes of emergent cardiac catheterization following pediatric cardiac surgery.
BACKGROUND
Although there is agreement of the importance of cardiac catheterization, especially interventional procedures, cardiac catheterization in postoperative critical care unit (CCU) period is often debated. The focus of this study was to explore the indications for and determinants of outcome after cardiac catheterization in this setting.


METHODS
Between March 2004 and October 2006, 49 children (2.8% of cardiac surgeries) underwent 62 catheterizations before discharge from the CCU. Morphological, surgical, and catheterization data were accrued and analyzed using parametric competing risks models and multivariable risk-hazard analysis.


RESULTS
Median age at surgery was 167 days (0-13.5 years) and time to catheterization was 8.5 (0-84) days following surgery. Catheterization procedures were either interventional (n = 35) or noninterventional (n = 27). Children who required a more urgent investigation following initial surgery more often had deployment of a stent at catheterization (P = 0.01) or subsequent surgical pulmonary artery augmentation (P < 0.01). Surgical reoperation was required following 23 (37%) catheterizations and was more common following index surgery involving a cavopulmonary shunt. Overall mortality was high (43%). Delayed invasive investigation beyond 2-3 weeks (P = 0.04) or a splinted sternum (P < 0.001) were risk factors for death. In addition, reoperation after a noninterventional catheterization predicted worse survival (P < 0.001).


CONCLUSIONS
The need for invasive investigation in the immediate CCU period is associated with a poor outcome, especially when the investigation is delayed or an intervention is not possible. Identification of at-risk patients may improve outcomes. Best outcomes follow expedient catheterization with definitive management (often stent deployment or pulmonary artery augmentation).
Asoh
Kentaro
K
Division of Cardiology, Department of Pediatrics, The Labatt Family Cardiac Center, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada.
Hickey
Edward
E
Dorostkar
Parvin C
PC
Chaturvedi
Rajiv
R
van Arsdell
Glen
G
Humpl
Tilman
T
Benson
Lee N
LN
D000293:Adolescent; D000800:Angioplasty, Balloon; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010166:Palliative Care; D011182:Postoperative Care; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome