title: Practice Variation in Single-Ventricle Patients Undergoing Elective Cardiac Catheterization: A Report from the Congenital Cardiac Catheterization Project on Outcomes (C3PO).
abstract: OBJECTIVE
  The objective of this study was to investigate variation in practice surrounding elective cardiac catheterization in patients with single-ventricle (SV) congenital heart disease.
  
  
  METHODS
  Patient and procedural characteristics and outcomes during SV catheterization were collected prospectively from eight centers using a web-based registry (Congenital Cardiac Catheterization Project on Outcomes). We attempted to identify a population of elective procedures by limiting the cohort in case type and timing. Cases were then stratified by stage of SV palliation (pre-bidirectional cavopulmonary anastomosis [pre-BCPA], pre-Fontan and post-Fontan) and limited by age. Subcohort analysis was performed by mode of airway management (assisted vs. spontaneous ventilation). Institutional variation was assessed.
  
  
  RESULTS
  Between 2/2007 and 6/2010, 1459 (10.1%) of 14 467 cases in the registry met the inclusion and exclusion criteria, including 326 pre-BCPA, 571 pre-Fontan and 562 post-Fontan procedures. Median patient age was 0.4 (interquartile range 0.3, 0.5), 2.6 (1.0, 3.4) and 9.6 (5.2, 15.4) years and weight was 5.6 (4.8, 6.4), 12.2 (10.5, 14), and 26.3 (16.6, 51.8) kg in the pre-BCPA, pre-Fontan and post-Fontan cohorts, respectively. Cases were more commonly diagnostic in the pre-BCPA cohort (57%) whereas they were more commonly interventional in the pre-Fontan (69%) and post-Fontan (77%) cohorts. At least one adverse event (AE) occurred in 210 cases (14.4%) overall, including 20% of pre-BCPA, 11% of pre-Fontan and 14% of post-Fontan catheterizations. Mode of airway management was associated with statistically significant, but clinically small differences in hemodynamic measures in the pre- and post-Fontan cohorts, but not in the pre-BCPA group. Considerable practice variation exists across centers with variability in airway management, AE rate, case type, interventions performed and fluoroscopy time, in all SV cohorts.
  
  
  CONCLUSIONS
  Elective catheterization in SV patients, frequently performed with intervention, is common among US congenital cardiac centers. However, important variation in practice exists during these procedures in SV patients, at all stages of palliation.
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Goldstein
authors.affiliation: The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA.
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Holzer
authors.affiliation: Heart Institute, Children's Hospital of Pittsburgh, Pittsburgh, Pa, USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Trucco
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Boston, Mass, USA.
authors.forename: Diego
authors.initials: D
authors.lastname: Porras
authors.affiliation: Division of Pediatric Cardiology, Washington University, St. Louis, Mo, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Murphy
authors.affiliation: Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wis, USA.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Foerster
authors.affiliation: Division of Cardiology, Rady Children's Hospital, San Diego, Calif, USA.
authors.forename: Howaida G
authors.initials: HG
authors.lastname: El-Said
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Beekman
authors.affiliation: Division of Pediatric Cardiology, Washington University, St. Louis, Mo, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac Catheterization; Congenital Heart Disease; Pediatric; Practice Variation; Quality Improvement; Single Ventricle