UC Davis Medical Center, Sacramento, CA, USA.
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine and Heart Institute, Cincinnati, OH, USA.
Pediatr Cardiol. 2023 Apr;44(4):795-805. doi: 10.1007/s00246-023-03126-9. Epub 2023 Feb 20.
Data on the frequency and outcome of surgical interventions as a result of adverse events (AE) encountered in the pediatric and congenital cardiac catheterization laboratory are limited. This study analyzes the outcomes of specific types of AE that are most likely to require immediate surgical intervention. Data from the C3PO registry were analyzed to identify specific types of significant vascular/cardiac trauma or technical adverse events (stent/device/coil embolization/migration). The relationship between these AE and an "adverse outcome" (defined as either surgery, ECMO, or death) were analyzed. Between 01/2014 and 12/2017, 25,731 cases were entered into the C3PO registry. Vascular or cardiac trauma were observed in 92 cases (0.36% cases in C3PO), and technical adverse events were observed in 176 cases (0.68% cases in C3PO). The two highest procedure type risk categories (PREDIC3T) accounted for 61% of the cases in the cardiac/vascular trauma cohort, and 34% in the technical AE cohort. For vascular/cardiac trauma, 24 (26%) had an adverse outcome, with ECMO in 8 (9%), surgery in 19 (20%), and death in 9 (10%). For technical AE 25 (14%) had an adverse outcome, with ECMO in 3 (2%), surgery in 23 (13%), and death in 3 (2%). Survival after cardiac surgery secondary to an AE was 68% for cardiac/vascular trauma, and 96% for technical adverse events. RF perforation of the pulmonary valve was the procedure most likely to result in cardiac/vascular trauma (10%), with 57% of those having an adverse outcome. Atrial septal interventions accounted for 29% of all adverse outcomes in the cardiac/vascular trauma cohort. Non-elective or emergent cases were associated with a significantly higher incidence of an adverse outcome for both, cardiac/vascular trauma (OR 7.1) and technical adverse events (OR 2.7). Surgery within the last 30 days was associated with a significantly higher incidence of an adverse outcome for cardiac/vascular trauma only (OR 4.2). Significant cardiac/vascular trauma or stent/device/coil embolization/migration are rare, but high consequence AE. With appropriate surgical and ECMO backup, a high survival can be achieved. The potential need for and impact of immediate surgical backup seems to be higher for cardiac/vascular trauma (in particular after specific case types), than for device/coil migration/embolization, and as such case specific backup arrangements are required.
关于儿科和先天性心脏导管实验室中因不良事件（AE）而进行的手术干预的频率和结果的数据有限。本研究分析了最有可能需要立即手术干预的特定类型 AE 的结果。对 C3PO 注册中心的数据进行了分析，以确定特定类型的严重血管/心脏创伤或技术不良事件（支架/器械/线圈栓塞/迁移）。分析了这些 AE 与“不良结果”（定义为手术、ECMO 或死亡）之间的关系。2014 年 1 月至 2017 年 12 月，C3PO 注册中心共录入 25731 例病例。92 例（C3PO 中 0.36%的病例）观察到血管或心脏创伤，176 例（C3PO 中 0.68%的病例）观察到技术不良事件。两个最高风险等级（PREDIC3T）的程序类型占心脏/血管创伤队列的 61%，技术 AE 队列的 34%。对于血管/心脏创伤，24 例（26%）出现不良结果，其中 ECMO 8 例（9%），手术 19 例（20%），死亡 9 例（10%）。对于技术 AE，25 例（14%）出现不良结果，其中 ECMO 3 例（2%），手术 23 例（13%），死亡 3 例（2%）。AE 继发的心脏手术后的存活率为心脏/血管创伤 68%，技术不良事件 96%。肺动脉瓣 RF 穿孔是最有可能导致心脏/血管创伤的程序（10%），其中 57%的患者出现不良结果。房间隔介入占心脏/血管创伤队列所有不良结果的 29%。非选择性或紧急病例与心脏/血管创伤（OR 7.1）和技术不良事件（OR 2.7）的不良结果发生率显著相关。在过去 30 天内进行的手术仅与心脏/血管创伤的不良结果发生率显著相关（OR 4.2）。严重的心脏/血管创伤或支架/器械/线圈栓塞/迁移很少见，但后果严重。如果有适当的外科和 ECMO 支持，可实现较高的存活率。心脏/血管创伤（特别是在特定病例类型后）似乎比器械/线圈迁移/栓塞更需要和更具影响，因此需要针对具体病例进行备份安排。
