Cardiac catheterization addressing early post-operative complications in congenital heart surgery-a single-center experience

Abstract

Background: Cardiac catheterization after congenital heart surgery may play an important role in the diagnosis and management of patients with a complicated or unusual post-operative course. The main objective of this study was to evaluate the safety, efficacy, and outcome of cardiac catheterization performed in the early post-operative period following congenital heart surgery. All patients who underwent cardiac catheterization after congenital heart surgery during the same admission of cardiac surgery from November 2015 to May 2018 were included in the study.

Results: Thirty procedures were performed for 27 patients (20 interventional and 10 diagnostic). The median age of the patients was 15 months (15 days to 20 years), median weight was 8.2 kg (3.4 to 53 kg), and median time from surgery was 3 days (0-32 days). Eleven procedures were performed for 11 patients on extracorporeal membrane oxygenation (ECMO) support. The main indications for catheterization included the inability to wean from ECMO (10 procedures) and cyanosis (10 procedures). Interventional procedures included angioplasty using stents (10 procedures, success rate of 90%), angioplasty using only balloons (2 procedures, success rate of 50%), and occlusion for residual shunts (8 procedures, success rate of 100%). No mortality was recorded during any procedure. Vasoactive-inotropic score had significantly decreased 48 h after catheterization when compared to pre-catheterization scores (p = 0.0001). Moreover, 72% of patients connected to ECMO support were successfully weaned from ECMO after catheterization. Procedural complications were recorded in 3 interventional procedures. Survival to hospital discharge was 55.5% and overall survival was 52%. Patients on ECMO support had a higher mortality than other patients.

Conclusion: Cardiac catheterization can be performed safely in the early post-operative period, and it could improve the outcome of the patient (depending on the complexity of the cardiac lesions involved).

Fig. 1

a Selective angiography for residual MBT shunt (white asterisk) in a patient after Fallot tetralogy repair; the patient developed heart failure symptoms due to significant left to right shunt. b The same patient after occlusion of the MBT shunt with vascular plug (yellow arrow) with no residual flow seen after aortic angiography. c Significant LPA stenosis (yellow arrow) with decreased left lung vascularity in another patient after Glenn surgery; the patient developed significant desaturation (68–73%) after surgery. d The same patient after LPA stenting (yellow arrow) with the improvement of left lung vascularity and patient saturation increased to 85%. MBT shunt, modified Blalock–Taussig shunt; LPA, left pulmonary artery

Fig. 2

Cardiac catheterization performed for a 6-month-old baby that presented late with DORV, subpulmonic VSD, intramural left coronary artery, and hypoplastic aortic arch after arterial switch operation on ECMO support. The patient developed an iatrogenic AO to RV fistula that led to severe coronary steal, severe cardiac dysfunction, and inability to wean from ECMO support. a Contrast injection in the neo-aorta revealed a large AO-RV fistula (white asterisk) with a coronary steal (coronary arteries are not seen with neo-aortic injection). b Selective injection of the AO-RV fistula (white asterisk).c, d Neo-aortic injection after fistula is occluded with vascular plugs showed no residual fistula and no more coronary steal as coronary arteries are seen well after neo-aortic injection (yellow arrows). Three days later, the patient was successfully disconnected from ECMO, and contractility progressively improved and the patient was discharged home. DORV double outlet right ventricle, VSD ventricular septal defect, VC venous cannula, AC arterial cannula, AO aorta, RV right ventricle, ECMO extracorporeal membrane oxygenation

Fig. 3

Kaplan–Meier survival curve demonstrating less survival among patients that underwent cardiac catheterization on ECMO support. ECMO extracorporeal membrane oxygenation