Abstract 18039: Cardiac Catheterization in the Early Postoperative Period Following Congenital Cardiac Surgery

Background: Early postoperative cardiac catheterization (EPOCC) is regarded as high-risk, particularly when patients are unstable or when interventions upon suture lines are anticipated. There are little data available demonstrating safety of EPOCC. Objective: The purpose of this study was to describe the safety of catheterizations performed in ≤ 30 days after congenital heart surgery. Methods/Results: All EPOCC performed within 30 days after congenital heart surgery between November 2004 and May 2013 were retrospectively reviewed. One-hundred and ninety-one patients, median age 0.4 years (range 0-18.5 years), weight 5.3 kg (range 2.2-98.5 kg) underwent EPOCC on median postoperative day 6 (range 0-30 days). One-hundred and twenty-seven catheterizations were diagnostic while 64 pts underwent a total of 89 interventional procedures. At time of EPOCC, 21 patients were receiving extracorporeal cardiopulmonary (ECMO) support. Among the 89 interventions were 64 dilation procedures, 60 of which were at surgical anastomotic areas. There was one procedural mortality due to tear during angioplasty. In addition, there were 4 major complications including need for ECMO support (n=2) and need for resuscitation (n=2). There were 42 deaths (21%) prior to hospital discharge. Interventional EPOCC was not associated with increased risk of mortality (p=0.87) as compared to those who only underwent a diagnostic catheterization. Binary logistic regression demonstrated that ECMO support at time of EPOCC (p=0.001), lower weight at EPOCC (p<0.001), and younger age at EPOCC (p<0.001) were associated with mortality. Conclusion: EPOCC is in most cases safe, even in small, critically ill children. Interventions, including angioplasty and stenting across suture lines, can be safely performed, though caution is essential. Interventional EPOCC is not associated with increased risk of mortality.