Tengler Anja, Michel Jörg, Arenz Claudia, Bauer UIrike, Beudt Jens, Horke Alexander, Kerst Gunter, Beckmann Andreas, Hofbeck Michael
Division of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilian University of Munich, Munich, Germany.
Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care, University Hospital Tuebingen, Tuebingen, Germany.
Thorac Cardiovasc Surg. 2025 Jan;73(S 03):e1-e10. doi: 10.1055/a-2514-7436. Epub 2025 Jan 13.
Interventional cardiac catheterizations have gained major importance in the treatment of congenital heart defects (CHDs). Since patients with CHDs frequently require lifelong medical care and sometimes subsequent invasive treatment, repeated radiation exposure during interventional procedures is a relevant issue concerning potential radiation-related risks. Therefore, a 9-year subanalysis on radiation data during interventional cardiac catheterizations from the German Registry for Cardiac Operations and Interventions in patients with CHDs was performed.
The German Registry for Cardiac Operations and Interventions in Patients with CHDs is a real-world, prospective all-comers database collecting clinical and procedural data on invasive treatment of CHDs. From January 2012 until December 2020, a total of 28,374 cardiac catheter interventions were recorded. For a homogeneous case mix and for obtaining comparable data, eight specified interventions were selected for detailed evaluation. The selected procedures were: atrial septal defect (ASD)/patent foramen ovale (PFO) occlusion, patent ductus arteriosus (PDA) occlusion, ventricular septal defect (VSD) occlusion, coarctation of the aorta (CoA) balloon dilatation and stent implantation, aortic valvuloplasty, pulmonary valvuloplasty, and transcatheter pulmonary valve implantation (TPVI). Data on radiation exposure included total fluoroscopy time (TFT), dose area product (DAP), and DAP per body weight (DAP/BW).
The cohort accounted for 9,350 procedures, including 3,426 ASD/PFO occlusions, 2,039 PDA occlusions, 599 aortic and 1,536 pulmonary valvuloplasties, 383 balloon dilatations and 496 stent implantations for CoA, 168 VSD occlusions, and 703 TPVI. Six hundred and ten ASD/PFO procedures (17.8%) were performed without radiation. During the 9-year period, median annual TFT, DAP, and DAP/BW showed a continuous decrease while radiation burden correlated with intervention complexity: For ASD/PFO and PDA occlusion, aortic and pulmonary valvuloplasty as well as balloon dilatation of CoA the median DAP/BW was <20.0 μGym/kg, while median values of 26.3 μGym/kg and 31.6 μGym/kg were noted for stent treatment of CoA and VSD closure, respectively. Radiation burden was highest in TPVI with a median TFT of 23.6 minutes, median DAP of 4,491 μGym, and median DAP/BW of 79.4 μGy*m/kg.
A decrease in radiation exposure was found in eight cardiac interventions from January 2012 to December 2020. Comparison with international registries revealed a good quality of radiation protection. The data underline the requirement of surveillance of radiation burden, especially in this patient group.
介入性心脏导管插入术在先天性心脏病（CHD）的治疗中已变得极为重要。由于先天性心脏病患者经常需要终身医疗护理，有时还需要后续的侵入性治疗，因此介入手术期间反复的辐射暴露是一个与潜在辐射相关风险有关的重要问题。因此，对德国先天性心脏病患者心脏手术和介入治疗登记处介入性心脏导管插入术期间的辐射数据进行了为期9年的亚分析。
德国先天性心脏病患者心脏手术和介入治疗登记处是一个真实世界的前瞻性全人群数据库，收集有关先天性心脏病侵入性治疗的临床和手术数据。从2012年1月至2020年12月，共记录了28374例心脏导管介入手术。为了实现病例组合的同质化并获得可比数据，选择了八项特定的介入手术进行详细评估。所选手术包括：房间隔缺损（ASD）/卵圆孔未闭（PFO）封堵术、动脉导管未闭（PDA）封堵术、室间隔缺损（VSD）封堵术、主动脉缩窄（CoA）球囊扩张术和支架植入术、主动脉瓣成形术、肺动脉瓣成形术以及经导管肺动脉瓣植入术（TPVI）。辐射暴露数据包括总透视时间（TFT）、剂量面积乘积（DAP）以及每体重的DAP（DAP/BW）。
该队列包括9350例手术，其中包括3426例ASD/PFO封堵术、2039例PDA封堵术、599例主动脉瓣和1536例肺动脉瓣成形术、383例CoA球囊扩张术和496例CoA支架植入术、168例VSD封堵术以及703例TPVI。610例ASD/PFO手术（17.8%）在无辐射情况下进行。在这9年期间，年度TFT、DAP和DAP/BW的中位数呈持续下降趋势，而辐射负担与手术复杂性相关：对于ASD/PFO和PDA封堵术、主动脉瓣和肺动脉瓣成形术以及CoA球囊扩张术，DAP/BW的中位数<20.0μGy·m/kg，而CoA支架治疗和VSD封堵术分别记录到中位数为(26.3μGy·m/kg)和(31.6μGy·m/kg)。TPVI的辐射负担最高，TFT中位数为23.6分钟，DAP中位数为4491μGy·m，DAP/BW中位数为79.4μGy·m/kg。
2012年1月至2020年12月期间，八项心脏介入手术的辐射暴露有所下降。与国际登记处的比较显示辐射防护质量良好。这些数据强调了监测辐射负担的必要性，尤其是在这一患者群体中。
