Barreto JA, Gauvreau K, Porras D, Esch JJ, Maschietto N, Quinn B, Bergersen L, Stein M, Callahan R.Pediatr Cardiol. 2023 Apr;44(4):806-815. doi: 10.1007/s00246-023-03129-6. Epub 2023 Mar 3.PMID: 36869157
Take Home Points
- Adverse events related to transcatheter pulmonary vein (PV) interventions are common with an incidence of ~25% though major/catastrophic adverse events (i.e. death, ecmo, stroke) are rare (1.8%).
- There is no association between higher number of PVs or the number of balloon/stent angioplasties and serious adverse events or high-level cardio-respiratory support following catheterization.
- Younger patients and those with abnormal hemodynamics secondary to PVS are more likely to have a serious adverse event or require high-level cardiorespiratory support following catheterization.
Commentary from Dr. Jonathon Hagel (C.S. Mott Children’s Hospital, University of Michigan), section editor of Congenital Heart Disease Interventions Journal Watch:
Transcatheter pulmonary vein (PV) interventions are the mainstay in therapy for patients with recurrent pulmonary vein stenosis (PVS). The authors sought to describe the frequency and predictors of serious adverse events (AEs) in patients undergoing transcatheter PV interventions through a retrospective review of a large cohort of patients at a quaternary care facility with a well-established PVS program. They also aimed to determine risk factors associated with high-level cardio-respiratory support following transcatheter PV intervention.
From March 1, 2014 to December 31, 2021, 240 patients with a total of 841 catheterizations involving PV interventions were included in this study. The median age at intervention was 12 months (IQR 9-26). A majority (84%) had PVS related to congenital heart disease, of which anomalous pulmonary venous return was the most common diagnosis (41%). More than half (57%) of cases involved five or more balloon dilations or stents.
At least one AE was reported in 208 (25%) of cases with one serious AE in 100 cases (12%) major AE in 14 cases (1.7%) and catastrophic AE in 1 case. Age less than 6 months, weight less than 5 Kg, low systemic arterial saturation, severely elevated mean PA pressure and pre-catheterization hospital admission were associate with a higher odds of serious AEs. There was no association between number of PVs undergoing intervention or number of balloon/stent angioplasties and serious AEs or high-level cardiorespiratory support following catheterization. Hospitalization prior to catheterization, patients younger than one year at time of catheterization and moderate-severe RV dysfunction were more likely to require high-level cardiorespiratory support following catheterization.
The authors conclude that given the lack of association between multiple interventions on a high number of PVs and adverse outcomes or high-level cardiorespiratory support, it is safe to plan such cases. Adverse events and high-level cardiorespiratory support are more likely in younger patients and those with abnormal hemodynamics secondary to PVS and therefore appropriate case planning for recovery and post-catheterization disposition should be made.
