Adverse Events Associated with Cardiac Catheterization in... : ASAIO Journal (original) (raw)

Pediatric Circulatory Support

Adverse Events Associated with Cardiac Catheterization in Children Supported with Ventricular Assist Devices

Power, Alyssa*; Navaratnam, Manchula†; Murray, Jenna M.‡; Peng, Lynn F.§; Rosenthal, David N.§; Dykes, John C.§; Yarlagadda, Vamsi V.§; Maeda, Katsuhide¶; Almond, Christopher S.§; Chen, Sharon§

From the *Department of Pediatrics, UT Southwestern Medical Center and Children’s Medical Center, Dallas, Texas, USA

†Department of Anesthesia, Lucile Salter Packard Children’s Hospital and Stanford University Hospital, Palo Alto, California, USA

‡Lucile Salter Packard Children’s Hospital, Palo Alto, California, USA

§Department of Pediatrics, Lucile Salter Packard Children’s Hospital and Stanford University Hospital, Palo Alto, California, USA

¶Department of Cardiothoracic Surgery, Lucile Salter Packard Children’s Hospital and Stanford University Hospital, Palo Alto, California, USA.

Submitted for consideration May 2021; accepted for publication in revised form November 2021.

Disclosure: There are no conflicts of interest to report

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Alyssa Power, Department of Pediatrics, Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235. E-mail: [email protected]

Abstract

Children on ventricular assist device (VAD) support can present several unique challenges, including small patient size, univentricular or biventricular congenital heart disease (1V- or 2V-CHD) and need for biventricular VAD (BiVAD) support. While cardiac catheterization can provide valuable information, it is an invasive procedure with inherent risks. We sought to evaluate the safety of catheterization in pediatric patients on VAD support. We performed a retrospective review of patients on VAD support who underwent catheterization at Lucile Packard Children’s Hospital between January 1, 2014 and September 1, 2019. Using definitions adapted from Pedimacs, adverse events (AEs) after catheterization were identified, including arrhythmia; major bleeding or acute kidney injury within 24 hours; respiratory failure persisting at 24 hours; and stroke, pericardial effusion, device malfunction, bacteremia or death within 7 days. AEs were categorized as related or unrelated to catheterization. Sixty procedures were performed on 39 patients. Underlying diagnoses were dilated cardiomyopathy (48%), 1V-CHD (35%), 2V-CHD (8%), and other (8%). Devices were implantable continuous flow (72%), paracorporeal pulsatile (18%) and paracorporeal continuous flow (10%). Catheterizations were performed on patients in the ICU (60%), on inotropic support (42%), with deteriorating clinical status (37%) and on BiVAD support (12%). There were 9 AEs possibly related to catheterization including 6 episodes of respiratory failure, 2 major bleeding events, and 1 procedural arrhythmia. AE occurrence was associated with ICU status (P = 0.01), BiVAD support (P = 0.04) and procedural indication to evaluate worsening clinical status (P = 0.04). Despite high medical acuity, catheterization can be performed with an acceptable AE profile in children on VAD support.