CLINICAL RESEARCH: CATHETER INTERVENTIONS FOR CONTENITAL DISEASE
Interventional catheterization performed in the early postoperative period after congenital heart surgery in children
Evan M. Zahn, MD, FACC*,*,
Nancy C. Dobrolet, MD*,
David G. Nykanen, MD*,
Jorge Ojito, CCP ,
Robert L. Hannan, MD and
Redmond P. Burke, MD
* Cardiology, Miami Children's Hospital, Miami, Florida, USA
Cardiac Surgery, Miami Children's Hospital, Miami, Florida, USA
Manuscript received January 24, 2003;
revised manuscript received October 8, 2003,
accepted October 20, 2003.
* Reprint requests and correspondence: Dr. Evan M. Zahn, Miami Children's Hospital, 3200 SW 60th Court, Suite 104, Miami, Florida 33155, USA.
evan.zahn{at}mch.com
OBJECTIVES: The purpose of this study was to examine the safety and efficacy of interventional catheterization performed early after congenital heart surgery.
BACKGROUND: Transcatheter interventions performed in the early postoperative period are viewed as high risk. To date, there have been limited published data regarding these procedures.
METHODS: All catheterizations performed within six weeks after congenital heart surgery between August 1995 and January 2001 were retrospectively reviewed. A cardiac anesthesiologist, cardiac intensivist, cardiac surgeon, and operating room team were available for all cases. Interventional procedures were performed based on clinical indications, regardless of the time elapsed from surgery.
RESULTS: Sixty-two patients, median age four months (2 days to 11 years), weight 4.7 kg (2.3 to 45 kg), underwent 66 catheterizations on median postoperative day 9 (0 to 42 days). Thirty-five cases involved 50 interventional procedures. Nine patients required extracorporeal cardiopulmonary support. Success rates by procedure were: angioplasty, 100%; stent implantation, 87%; vascular/septal occlusion, 100%; and palliative pulmonary valvotomy, 75%. Complications included stent migration (one patient), cerebral vascular injury (one patient), and left pulmonary artery stenosis (one patient). Thirty procedures involved angioplasty or stent implantation, including 26 involving a recently created suture line. Suture disruption or trans-mural vascular tears were not observed. There was no procedural mortality. Thirty-day survival for patients undergoing intervention was 83%.
CONCLUSIONS: Transcatheter interventions can be successfully performed in the early postoperative period. These procedures can have a positive impact on patient outcome; however, they should be performed only by a pediatric interventional cardiologist supported by a multi-disciplinary team.
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Abbreviations and Acronyms
| | CPS | = cardiopulmonary support | | ECMO | = extracorporeal membrane oxygenators | | mBTS | = modified Blalock-Taussig shunt | | PA | = pulmonary artery |
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