Catheterization in Children With Pulmonary Hypertension
What are the frequency of and risk factors for catastrophic adverse outcomes in children with pulmonary hypertension (PH) undergoing cardiac catheterization?
Review of data from the Pediatric Health Information Systems (PHIS) database was performed. Children and young adults 0-21 years of age with PH undergoing cardiac catheterization at centers participating in the PHIS database between 2007 and 2012 were studied. Mixed-effect multivariable regression was used to assess the association between prespecified covariates and the risk of the composite outcome (death and/or initiation of mechanical circulatory support within 1 day of cardiac catheterization after adjustment for patient- and procedure-level factors).
The study included 6,339 catheterization procedures on 4,401 patients with a diagnosis of PH from 38 of the 43 centers reporting data to the PHIS database. The observed risk of the composite endpoint was 3.5%, while the adjusted risk in multivariate modeling was 3.3%. Predictors of increased risk of adverse outcomes included younger age at catheterization, cardiac operation in the same admission as the catheterization, preprocedural systemic vasodilator infusion, and hemodialysis. Preprocedure use of pulmonary vasodilators was associated with reduced risk of the composite outcome. Finally, higher center catheterization volume appeared to be associated with lower risk for catastrophic complications.
The authors concluded that risk of cardiac catheterization in children and young adults with PH is high, and is influenced by patient-level factors.
This multicenter report describes high rates of complications in young patients with PH. Although significantly higher than other reports (risk of death 0-0.6%), this may be biased by the inclusion of only patients with catheterization tied to an inpatient admission. The studied patient population is likely representative of young patients with PH undergoing catheterizations at tertiary centers. This study should prove helpful in counseling patients and their families regarding risks of catheterization in patients with PH, and may help to inform clinicians as to the risk/benefit calculation of catheterization of inpatients with PH.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Congenital Heart Disease, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Pulmonary Hypertension, Hypertension
Keywords: Cardiac Catheterization, Catheterization, Dialysis, Health Information Systems, Heart Defects, Congenital, Hypertension, Hypertension, Pulmonary, Pediatrics, Risk Assessment, Risk Factors, Vasodilator Agents, Young Adult
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