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Risk Factors for Adverse Events in Children with Pulmonary Hypertension Undergoing Cardiac Catheterization

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Abstract

Pulmonary hypertension (PH) can lead to progressive heart failure with high morbidity and mortality. Cardiac catheterization (CC) is the gold standard for diagnosis and response to vasodilatory medications. The invasive nature of CC and associated anesthesia predispose this patient population to adverse events including death. Catheterization records were queried from 1/1/2011 to 10/31/2016. Patients with PH, defined as pulmonary vascular resistance (PVR) greater than 3 WU m2, pulmonary artery pressure above 20 mmHg, and pulmonary wedge pressure less than or equal to 15 mmHg, who underwent hemodynamic CC were included in this retrospective study. Both patients with and without congenital heart disease were included. There were 198 CC in 191 patients. Adverse events (n = 28, 14.1%) included cardiac arrest, increased respiratory support requiring ICU care, PH crisis, bradycardia/hypotension requiring intervention, and arrhythmias. Odds of an adverse event increased by 22% for every 15-min increase in procedure times (OR 1.22, CI 1.01–1.39, p = 0.002) and were significantly increased for procedures longer than 80 min (OR 3.75, CI 1.56–9.00, p = 0.007) (Fig. 1). Patients with an adverse event had higher mean pulmonary artery pressures while breathing oxygen (43 [35–58] versus 34 [27–44] mmHg, p = 0.017) and oxygen with inhaled nitric oxide (37 [32–56] versus 32 [25–40] mmHg, p = 0.026). Females carried more risk than males (OR 3.88, CI 1.44–10.40, p = 0.007). Younger age, medication regimens, prematurity, and genetic disease did not carry an increased risk. Adverse events are common in pediatric patients with PH undergoing CC. The risk of adverse events correlates with greater procedure times and higher mean pulmonary artery pressure. Minimizing procedure time may improve patient outcomes.

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Authors and Affiliations

  1. Division of Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Danish Vaiyani, Usama Kanaan, Christopher J. Petit & Holly Bauser-Heaton

  2. Division of Pediatrics, Emory University, Atlanta, GA, USA

    Michael Kelleman, Usama Kanaan, Christopher J. Petit & Holly Bauser-Heaton

  3. Division of Cardiac Anesthesia, Emory University, Atlanta, GA, USA

    Laura A. Downey

  4. Sibley Heart Center, 2835 Brandywine Rd Suite 300, Atlanta, GA, 30341, USA

    Holly Bauser-Heaton

Authors
  1. Danish Vaiyani
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  2. Michael Kelleman
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  3. Laura A. Downey
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  4. Usama Kanaan
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  5. Christopher J. Petit
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  6. Holly Bauser-Heaton
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by DV and MK. The first draft of the manuscript was written by DV, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Credit Author Statement: DV: conceptualization, investigation, writing—original draft. MK: formal analysis, visualization, writing—review, & editing. LD: conceptualization, writing—review & editing. UK: conceptualization, writing—review & editing. CJP: conceptualization, writing—review & editing. HB-H: conceptualization, writing—review & editing, supervision.

Corresponding author

Correspondence to Holly Bauser-Heaton.

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The authors declare that they have no conflict of interest.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board (IRB) of Children’s Healthcare of Atlanta approved this study.

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Not obtained due to retrospective study design.

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Vaiyani, D., Kelleman, M., Downey, L.A. et al. Risk Factors for Adverse Events in Children with Pulmonary Hypertension Undergoing Cardiac Catheterization. Pediatr Cardiol 42, 736–742 (2021). https://doi.org/10.1007/s00246-020-02535-4

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  • DOI: https://doi.org/10.1007/s00246-020-02535-4

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