Young PH Patients Have Increased Risk During Cardiac Catheterization, Study Contends

Children with pulmonary hypertension (PH) are a relatively high-risk group for cardiac catheterization, a new study shows. In turn, hospital experience with the procedure reduces this risk.

The research that supports that finding, “Risk Factors for Major Early Adverse Events Related to Cardiac Catheterization in Children and Young Adults With Pulmonary Hypertension: An Analysis of Data From the IMPACT (Improving Adult and Congenital Treatment) Registry,” was published in the Journal of the American Heart Association.

Cardiac catheterization is a procedure to assess how well the heart is working. A catheter (a thin, hollow tube) is inserted into a large blood vessel that leads to the heart, in order to measure pressure and blood flow.

The gold standard for diagnosis, classification, risk classification, and follow‐up of PH patients is right‐sided heart catheterization (RHC).

Despite being considered a safe procedure, children with PH may be less stable than other children during induction of and recovery from anesthesia, as well as during RHC itself, which increases the risk of severe adverse outcomes. However, assessments of the risk associated with RHC in PH patients vary significantly, depending on whether they are derived from single-center or multicenter registries, or from administrative databases.

The wide spectrum of disease severity, comorbid conditions, and limited volume of hospital databases make risk measurement a challenge.

Aiming to overcome these challenges, scientists conducted a retrospective, multicenter study using data from IMPACT — a clinical registry of catheterizations from both primary pediatric and general hospitals in the U.S. The registry includes detailed clinical, hemodynamic (referring to blood flow), and procedural data, providing a thorough assessment of this patient population.

The team analyzed the risk of catastrophic adverse outcomes after catheterization in children and young adults with PH (0 to 21 years old). Researchers also aimed to identify risk factors.

The research included 8,111 procedures performed on 7,729 subjects at 77 centers, a representative national sample, the authors said.

The overall risk of catastrophic adverse event — defined as death within one day of catheterization, cardiac arrest or start of ECMO for cardiac support – was 1.4 percent, while the risk of death before hospital discharge was 5.2 percent.

Results also showed that catheterization in prematurely born neonates and non-premature infants correlated with an increased risk of catastrophic adverse events. Pre-catheterization treatment with inotropes — which increase the ability of the heart muscle to contract – and lower systemic arterial saturation were also found to be associated with an increased risk of adverse events.

The data further revealed that increasing volumes of catheterization in PH patients were linked to a decreased risk of catastrophic adverse events; whereas increasing pulmonary vascular resistance — the resistance to blood flow in pulmonary blood vessels — and pulmonary artery pressures were associated with an increased risk.

According to the team, this study “demonstrates a significant association between larger pulmonary hypertension case volume and lower risk of catastrophic adverse event, which should motivate research into whether the benefits seen at large centers are attributable to transmissible best practices or are intrinsic results of scale.”

Overall, the team concluded, “young patients with PH are a high‐risk population for diagnostic and interventional cardiac catheterization. Hospital experience with PH is associated with reduced risk, independent of total catheterization case volume.”