Presentation Title

Hemodynamic Consequence of Interventional Cardiac Catheterization in the Early Postoperative Period after Congenital Heart Surgery

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Event

Start Date

12-2-2010 12:00 AM

Abstract

Objective. The purpose of this study was to evaluate the safety/efficacy of cardiac catheterization performed within thirty days of congenital heart surgery (CHS). Background. While still considered to be high risk procedures, interventional and diagnostic cardiac catheterization in the early postoperative period are being performed more frequently in the current era. There is no data currently available concerning the acute hemodynamic consequences of these procedures. Methods. We completed a retrospective review of all catheterizations performed between 2/2002 and 2/2008 that occurred within 30 days of CHS. Procedures were performed as a result of failure to progress or hemodynamic deterioration in the early postoperative period. The physiologic consequence of these procedures was determined by assessing the affects pre and post procedure on hemodynamic parameters, metabolic markers of tissue perfusion and renal function, and inotrope requirements. Results. During the study period, there were 1799 congenital heart surgeries (1545 cardiopulmonary bypass cases). There were 100 pts (6%) at a median age of 124 d (5 d- 16yr; neonates n=38, infants n=35) and mean weight 7.73 kg (1.7-37.8 kg) who underwent catheterization on mean postoperative d 11 (0-30 d). Sixty-three cases received a total of 71 interventions. Prior to catheterization, 62% were intubated and 11% were requiring mechanical cardiopulmonary support (CPS). Complications in the interventional group included arrhythmias in 5, intimal tears with insignificant hemorrhagic loss in 2, atrial septal stent failure requiring surgical retrieval in 1, and cardiac arrest in 1 pt. Consequence of acute postoperative intervention included an increase in creatinine from 0.6 pre-cath to 0.84 immediate post-cath (p=0.03) and back to 0.7 at 24 hrs (p=0.04). Blood lactate decreased from 1.84 pre-cath to 1.27 at 24 hrs post-cath (p=0.01) while no significant change was seen in the diagnostic group (p=0.7). There was no significant change in HR, systolic or diastolic BP, sPO2, or inotrope scores immediately or at 24 hrs post cath. There were 5 pts who required preoperative CPS with 2 being weaned off support after cath. One pt required CPS immediately post cath. Seven pts undergoing intervention died at 0-12 days post cath (mean 5d). Survival for pts not requiring cardiac catheterization postoperatively was 99%. Survival for pts undergoing diagnostic cath (81%) did not differ significantly for those who underwent intervention (90%). Conclusions. Cardiac catheterization was performed on 5.7% of pts undergoing CHS in our series. Acute postoperative cardiac catheter intervention was performed in 3.5%. Intervention or diagnostic catheterization was performed on those pts at highest risk for death in the postoperative period. Catheter intervention did not increase the risk for death. Those pts undergoing catheter intervention did not seem to undergo any significant negative hemodynamic or renal consequence from their catheterization but achieved mild improvement in tissue perfusion. Grants. Hospital support.

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Feb 12th, 12:00 AM

Hemodynamic Consequence of Interventional Cardiac Catheterization in the Early Postoperative Period after Congenital Heart Surgery

Objective. The purpose of this study was to evaluate the safety/efficacy of cardiac catheterization performed within thirty days of congenital heart surgery (CHS). Background. While still considered to be high risk procedures, interventional and diagnostic cardiac catheterization in the early postoperative period are being performed more frequently in the current era. There is no data currently available concerning the acute hemodynamic consequences of these procedures. Methods. We completed a retrospective review of all catheterizations performed between 2/2002 and 2/2008 that occurred within 30 days of CHS. Procedures were performed as a result of failure to progress or hemodynamic deterioration in the early postoperative period. The physiologic consequence of these procedures was determined by assessing the affects pre and post procedure on hemodynamic parameters, metabolic markers of tissue perfusion and renal function, and inotrope requirements. Results. During the study period, there were 1799 congenital heart surgeries (1545 cardiopulmonary bypass cases). There were 100 pts (6%) at a median age of 124 d (5 d- 16yr; neonates n=38, infants n=35) and mean weight 7.73 kg (1.7-37.8 kg) who underwent catheterization on mean postoperative d 11 (0-30 d). Sixty-three cases received a total of 71 interventions. Prior to catheterization, 62% were intubated and 11% were requiring mechanical cardiopulmonary support (CPS). Complications in the interventional group included arrhythmias in 5, intimal tears with insignificant hemorrhagic loss in 2, atrial septal stent failure requiring surgical retrieval in 1, and cardiac arrest in 1 pt. Consequence of acute postoperative intervention included an increase in creatinine from 0.6 pre-cath to 0.84 immediate post-cath (p=0.03) and back to 0.7 at 24 hrs (p=0.04). Blood lactate decreased from 1.84 pre-cath to 1.27 at 24 hrs post-cath (p=0.01) while no significant change was seen in the diagnostic group (p=0.7). There was no significant change in HR, systolic or diastolic BP, sPO2, or inotrope scores immediately or at 24 hrs post cath. There were 5 pts who required preoperative CPS with 2 being weaned off support after cath. One pt required CPS immediately post cath. Seven pts undergoing intervention died at 0-12 days post cath (mean 5d). Survival for pts not requiring cardiac catheterization postoperatively was 99%. Survival for pts undergoing diagnostic cath (81%) did not differ significantly for those who underwent intervention (90%). Conclusions. Cardiac catheterization was performed on 5.7% of pts undergoing CHS in our series. Acute postoperative cardiac catheter intervention was performed in 3.5%. Intervention or diagnostic catheterization was performed on those pts at highest risk for death in the postoperative period. Catheter intervention did not increase the risk for death. Those pts undergoing catheter intervention did not seem to undergo any significant negative hemodynamic or renal consequence from their catheterization but achieved mild improvement in tissue perfusion. Grants. Hospital support.