Clem Aaron, Awadallah Sami, Amin Zahid
University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA.
Pediatr Cardiol. 2017 Oct;38(7):1332-1336. doi: 10.1007/s00246-017-1664-z. Epub 2017 Jun 21.
The aim of the study was to evaluate the safety, feasibility, and economic benefit of a high-volume operator performing common interventional procedures in a rural region of the United States (U.S.). Rural areas of the U.S., even with well-equipped cardiac catheterization laboratories, may not have a full-time pediatric interventional cardiologist (PIC); this requires patients to travel out of state even for simple interventions. Since 2005, we have adopted a policy of performing cardiac catheterizations and common interventional procedures with a visiting PIC. We reviewed data of all patients who underwent cardiac catheterizations from May 2005 through March 2015 at our center. Variables analyzed were type of procedure, results, and follow-up six months after procedure. 197 catheterizations were performed, of which 80 were for single atrial septal defect (ASD), 29 for fenestrated ASD, 49 for patent ductus arteriosus (PDA), and 39 for other procedures. Device closure of single ASD was successful in 75 of 79 attempts and in 27 of 28 attempts for fenestrated ASD. PDA closure was successful in 45 of 46 attempts. Follow-up data of 6 months or more were available for 127 patients. All but two patients had no cardiovascular symptoms at 6 months. There were four minor complications and no major complications. With a technical success rate of 94.9% for single ASD closure, 97.8% for PDA closure, and results comparable to those of multi-institutional registries, cardiac catheterization and interventions can be performed safely with excellent results. Performing procedures in such an arrangement is safe, feasible, and economically beneficial.
本研究的目的是评估在美国农村地区由高年资操作人员进行常见介入手术的安全性、可行性和经济效益。美国农村地区，即使配备了设备完善的心脏导管实验室，可能也没有全职的儿科介入心脏病专家（PIC）；这就要求患者即使进行简单的介入手术也要前往其他州。自2005年以来，我们采取了由客座PIC进行心脏导管插入术和常见介入手术的政策。我们回顾了2005年5月至2015年3月在我们中心接受心脏导管插入术的所有患者的数据。分析的变量包括手术类型、结果以及术后六个月的随访情况。共进行了197例导管插入术，其中80例为单纯房间隔缺损（ASD），29例为多孔型ASD，49例为动脉导管未闭（PDA），39例为其他手术。单纯ASD封堵术在79次尝试中有75次成功，多孔型ASD封堵术在28次尝试中有27次成功。PDA封堵术在46次尝试中有45次成功。127例患者有6个月或更长时间的随访数据。除两名患者外，所有患者在6个月时均无心血管症状。有4例轻微并发症，无严重并发症。单纯ASD封堵术的技术成功率为94.9%，PDA封堵术为97.8%，结果与多机构登记数据相当，心脏导管插入术和介入手术可以安全进行且效果良好。以这种安排进行手术是安全、可行且具有经济效益的。
