Early Intervention: Post-Operative Cardiac Catheterization in Children
Interview | At the 2014 AHA Scientific Sessions in Chicago, Illinois, CardioSource WorldNews: Interventions spoke with Christopher J. Petit, M.D, an associate professor of pediatrics at the Children's Healthcare of Atlanta and Emory University, and senior author of "Cardiac Catheterization in the Early Post-Operative Period Following Congenital Cardiac Surgery." In this interview, Dr. Petit sheds light on cardiac catheterization and its value in the evaluation and treatment of patients with congenital heart disease.
In your center, who are these patients who get sent for potential catheterization?
CHRISTOPHER PETIT, MD: Mostly, these are young childreninfants, neonateswho have had complex congenital heart disease surgery and, early in their post-operative course, are doing very poorly. So they're a high-risk population to begin with.
What did you want to look at with this paper?
Well, we're asked commonly by our surgeons in our ICU staff to help in the managementand even the therapy[as well as] the treatment of these patients, and so what I wanted to do was look and see if this [cardiac catheterization] was making a differenceand more importantly, is it safe and is it effective?
And how many patients did you look at?
We had about 90 patientssome of them underwent more than one procedure in their early post-operative period.
So these are definitely high-risk people who are in desperate need of some information that a cath can give them? That's right. Yes.
What did you find?
Well, we found that, in general, this was a safe procedure, even when you take very small neonatesyou know, five or six pounds even, who have just had a complex operation; it is possible and it is safe to take them to the cardiac cath lab and, under general anesthesia, perform a diagnostic catheterizationand, at times, even an interventional procedureon them.
Now, theoretically, post-operatively, it should be a higher risk, period?
Is it the great care? I mean, what explains the positive results that you're seeing?
Well, I think one thing that our paper highlightsand we mentioned this in the discussionis that it's a real team approach. We have the surgical team available in case there is any misadventure. We have dedicated cardiac anesthesiologists who provide the minute-by-minute and second-by-second care to that ill child. And, then, we have the dedicated catheterization interventionalistsmyself and my colleagueswho perform and focus on the performance of that very technically challenging procedure.
What did you find when you took a look at the aftermath? Was there a positive result from most of these cases? Did they get something really valuable [like] information from the catheterization?
That's a great question. I think, in the majority of cases, our procedure did either result in an intervention at the time of the catheterization or resulted in the surgeon taking the patient back to the operating room for definitive correction. Overall, these patients who are young (infants and neonates), who are very ill and have had complex heart operations, overall, their survival was not great. So survival was less: not quite 75% leaving the hospital. So, unfortunately, this is a high-risk population and, despite what we'd consider safe procedures, they still endured a lot of mortality.
So what's the clinical take-home message?
Well, in the centers where dedicated anesthesiology and surgical backup are possible, early post-op cardiac catheterization is safe and can be effective for those patients who are not doing well.
And in terms of teamwork, how long did it take you to get a team together that really worked?
Well, it's an evolution, as you might guess. And it still evolves, so we still get better and better every day at this. And I think that our center is like many centers: We always we review our outcomes and ask ourselves, "How can we get better?" So this has been going on for years, before I got there, and it continues to this day. And [with] studies like the one that we're discussing, we took back to our own colleagues and said, "Well, look, here are some areas that we could have done better, and now let's focus on those patients who are really, really ill."
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