There is little difference in adverse events between diagnostic and interventional procedures in patients with congenital heart defects, but there are significant differences among age groups, with newborns at the highest risk, according to a study published Feb. 23 in Cardiology in the Young.

The study used data from the ACC’s IMPACT Registry between January 2011 and March 2013, and researchers assessed records from 19,797 patients. Of that number, 35 percent of procedures performed were for diagnostic purposes and 65 percent for interventions. Anesthesia was used in 84.1 percent of diagnostic procedures and 87.8 percent of interventional ones.    

Major adverse events were defined as a need for a permanent or temporary pacemaker; cardiac arrest; tamponade requiring pericardial drainage; embolic stroke (within 72 hours); and unplanned cardiac surgery due to catheterization complications.

Other adverse events reported included arrhythmias, including any that required medication; new heart valve regurgitation; air embolus; device malposition or thrombus requiring surgery; device embolization, requiring that it be removed by catheterization or surgery; airway event requiring intubation; and bleeding at the access site or in other places in the body.

Results showed little difference in adverse events between diagnostic and interventional procedures, with 10 percent occurring in diagnostic procedures and 11.1 percent in interventional ones. Differences in adverse events during diagnostic and interventional catheterizations by age group were prevalent, with 30.9 percent vs. 30.2 percent among newborns (age <30 days); 16.3 percent vs. 20.8 percent among infants (age 30 days – 1 year); 5.5 percent vs. 7.3 percent among children (age 1 year – younger than 18 years); and 6.3 percent vs. 9.0 percent among adults (age greater than or equal to 18 years). 

The authors conclude that “the IMPACT Registry is gathering data to set national benchmarks for diagnostic and certain specific interventional procedures. We are seeing little differences in procedural characteristics or adverse events in diagnostic procedures compared with interventional procedures overall, but there is significant variation in adverse events amongst age categories.” They add that moving forward, “risk stratification and patient acuity scores will be required for further analysis of these differences.”

“This study along with others being reported from the Registry is allowing some benchmarking to occur so that centers can use this information for quality improvement,” said Robert Vincent, MD, CM, FACC, the study’s lead author, a pediatric cardiologist affiliated with Children’s Healthcare of Atlanta, and a member of the ACC’s Adult Congenital and Pediatric Cardiology Section Leadership Council. “[However] we don’t have data on attribution of adverse events to the procedure, case complexity and risk stratification. As a result, it is difficult to make inter-institutional comparisons.” 

Keywords: Anesthesia, Arrhythmias, Cardiac, Benchmarking, Cardiac Surgical Procedures, Catheterization, Drainage, Embolism, Heart Arrest, Heart Defects, Congenital, Heart Valves, Infant, Newborn, Intubation, Patient Acuity, Quality Improvement, Registries, Stroke, Thrombosis, National Cardiovascular Data Registries, IMPACT Registry

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