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CLINICAL RESEARCH

Complications of Right Heart Catheterization Procedures in Patients With Pulmonary Hypertension in Experienced Centers

Marius M. Hoeper, MD^_*,_*, Stephen H. Lee, MD, Robert Voswinckel, MD, Massimiliano Palazzini, MD, Xavier Jais, MD^||, Alessandro Marinelli, MD, Robyn J. Barst, MD^¶, Hossein A. Ghofrani, MD, Zhi-Cheng Jing, MD^||, Christian Opitz, MD^#, Hans-Juergen Seyfarth, MD^_**, Michael Halank, MD, Vallerie McLaughlin, MD, Ronald J. Oudiz, MD, Ralf Ewert, MD^||||, Heinrike Wilkens, MD^¶¶, Stefan Kluge, MD^##, Hinrich-Cordt Bremer, MD^_***, Eva Baroke^_* and Lewis J. Rubin, MD

^_* Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
Division of Pulmonary and Critical Care Medicine, University of California, San Diego Medical Center, La Jolla, California
University of Giessen Lung Center, Department of Internal Medicine, Giessen, Germany
Institute of Cardiology, University of Bologna, Bologna, Italy
^|| Service de Pneumologie, Antoine Béclère Hospital, South-Paris University, Clamart, France
^¶ Columbia University College of Physicians and Surgeons, New York, New York
^# Medizinische Klinik II–Kardiologie, DRK Kliniken Berlin Westend, Berlin, Germany
^_** Department of Pulmonary Medicine, University Leipzig, Leipzig, Germany
Internal Medicine I, University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Liu Center for Pulmonary Hypertension, Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California
^{|| ||} Department of Respiratory Medicine, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany
^¶¶ Department of Respiratory Medicine, University of the Saarland, Homburg, Germany
^## Department of Intensive Care, University Hospital Eppendorf, Hamburg, Germany
^_*** Department of Respiratory Medicine, University Hospital Freiburg, Freiburg, Germany

Manuscript received May 15, 2006; revised manuscript received July 20, 2006, accepted July 24, 2006.

^_* Reprint requests and correspondence: Dr. Marius M. Hoeper, Department of Respiratory Medicine, Hannover Medical School, 30623 Hannover, Germany. (Email: hoeper.marius{at}mh-hannover.de).

OBJECTIVES: This study sought to assess the risks associated with right heart catheter procedures in patients with pulmonary hypertension.

BACKGROUND: Right heart catheterization, pulmonary vasoreactivity testing, and pulmonary angiography are established diagnostic tools in patients with pulmonary hypertension, but the risks associated with these procedures have not been systematically evaluated in a multicenter study.

METHODS: We performed a multicenter 5-year retrospective and 6-month prospective evaluation of serious adverse events related to right heart catheter procedures in patients with pulmonary hypertension, as defined by a mean pulmonary artery pressure >25 mm Hg at rest, undergoing right heart catheterization with or without pulmonary vasoreactivity testing or pulmonary angiography.

RESULTS: During the retrospective period, 5,727 right heart catheter procedures were reported, and 1,491 were reported from the prospective period, for a total of 7,218 right heart catheter procedures performed. The results from the retrospective and the prospective analyses were almost identical. The overall number of serious adverse events was 76 (1.1%, 95% confidence interval 0.8% to 1.3%). The most frequent complications were related to venous access (e.g., hematoma, pneumothorax), followed by arrhythmias and hypotensive episodes related to vagal reactions or pulmonary vasoreactivity testing. The vast majority of these complications were mild to moderate in intensity and resolved either spontaneously or after appropriate intervention. Four fatal events were recorded in association with any of the catheter procedures, resulting in an overall procedure-related mortality of 0.055% (95% confidence interval 0.01% to 0.099%).

CONCLUSIONS: When performed in experienced centers, right heart catheter procedures in patients with pulmonary hypertension are associated with low morbidity and mortality rates.

Abbreviations and Acronyms   CI = confidence interval   NO = nitric oxide   PAH = pulmonary arterial hypertension

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