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Technical factors are associated with complications and repeat intervention in neonates undergoing transcatheter right ventricular decompression for pulmonary atresia and intact ventricular septum: results from the congenital catheterisation research collaborative

Published online by Cambridge University Press:  18 June 2018

Christopher J. Petit*
Affiliation:
Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Athar M. Qureshi
Affiliation:
Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
Andrew C. Glatz
Affiliation:
University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Michael S. Kelleman
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
Courtney E. McCracken
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
R. Allen Ligon
Affiliation:
Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Namrita Mozumdar
Affiliation:
University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Wendy Whiteside
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Asra Khan
Affiliation:
Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
Bryan H. Goldstein
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
*
Author for correspondence: C. J. Petit, MD, Associate Professor of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30322, USA. Tel: 404 695 0711; Fax: 404 785 0998; E-mail: petitc@kidsheart.com

Abstract

Background

Transcatheter right ventricle decompression in neonates with pulmonary atresia and intact ventricular septum is technically challenging, with risk of cardiac perforation and death. Further, despite successful right ventricle decompression, re-intervention on the pulmonary valve is common. The association between technical factors during right ventricle decompression and the risks of complications and re-intervention are not well described.

Methods

This is a multicentre retrospective study among the participating centres of the Congenital Catheterization Research Collaborative. Between 2005 and 2015, all neonates with pulmonary atresia and intact ventricular septum and attempted transcatheter right ventricle decompression were included. Technical factors evaluated included the use and characteristics of radiofrequency energy, maximal balloon-to-pulmonary valve annulus ratio, infundibular diameter, and right ventricle systolic pressure pre- and post-valvuloplasty (BPV). The primary end point was cardiac perforation or death; the secondary end point was re-intervention.

Results

A total of 99 neonates underwent transcatheter right ventricle decompression at a median of 3 days (IQR 2–5) of age, including 63 patients by radiofrequency and 32 by wire perforation of the pulmonary valve. There were 32 complications including 10 (10.5%) cardiac perforations, of which two resulted in death. Cardiac perforation was associated with the use of radiofrequency (p=0.047), longer radiofrequency duration (3.5 versus 2.0 seconds, p=0.02), and higher maximal radiofrequency energy (7.5 versus 5.0 J, p<0.01) but not with patient weight (p=0.09), pulmonary valve diameter (p=0.23), or infundibular diameter (p=0.57). Re-intervention was performed in 36 patients and was associated with higher post-intervention right ventricle pressure (median 60 versus 50 mmHg, p=0.041) and residual valve gradient (median 15 versus 10 mmHg, p=0.046), but not with balloon-to-pulmonary valve annulus ratio, atmospheric pressure used during BPV, or the presence of a residual balloon waist during BPV. Re-intervention was not associated with any right ventricle anatomic characteristics, including pulmonary valve diameter.

Conclusion

Technical factors surrounding transcatheter right ventricle decompression in pulmonary atresia and intact ventricular septum influence the risk of procedural complications but not the risk of future re-intervention. Cardiac perforation is associated with the use of radiofrequency energy, as well as radiofrequency application characteristics. Re-intervention after right ventricle decompression for pulmonary atresia and intact ventricular septum is common and relates to haemodynamic measures surrounding initial BPV.

Type
Original Article
Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Petit CJ, Qureshi AM, Glatz AC, Kelleman MS, McCracken CE, Ligon RA, Mozumdar N, Whiteside W, Khan A, Goldstein BH. (2018) Technical factors are associated with complications and repeat intervention in neonates undergoing transcatheter right ventricular decompression for pulmonary atresia and intact ventricular septum: results from the congenital catheterisation research collaborative. Cardiology in the Young 28: 1042–1049. doi: 10.1017/S1047951118000756

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