Publication Date

9-2022

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Abstract

Intro: Historically, early postoperative (<6weeks) cardiac catheterization (EPOCC) was considered high risk and often delayed. Recently, the safety of early postoperative cardiac catheterization has been demonstrated. The timing of catheterization in the struggling postoperative patient remains variable and optimal timing remains uncertain. There is limited data on the impact of EPOCC on outcomes such as length of stay, duration of mechanical ventilatory or extracorporeal support, and surgical or catheter- based interventions. The aim of this study was to describe our experience with EPOCC and its impact on management, length of stay, and duration of mechanical ventilatory support. Methods: This is a descriptive retrospective cohort study of patients who underwent cardiac surgery between 01/01/2010 and 12/31/2019 and cardiac catheterization within 30 days after surgery. Patients with catheterization for LA decompression on ECMO, endomyocardial biopsy, or BAS post hybrid procedure were excluded. We collected information surrounding timing, indication, and complications of catheterization, duration of mechanical ventilation/ECMO, and ICU/hospital LOS and compared these differences in patients who underwent EPOCC < 72hours (earlier) versus >72hours (later). Data was analyzed using IBM SPSS, version 28. Chi-square and Student’s t-test, or appropriate nonparametric tests were used to compare categorical and continuous variables, respectively. Results: There were 2542 surgeries performed during the study period with 167 patients undergoing cardiac catheterization within the defined 30 days. Twenty-six patients met exclusion criteria, leaving 141 patients for analyses. Median time from surgery to EPOCC was 10 days (1-30), with 26 patients(18.4%) having an earlier EPOCC. Interventions were performed in 70 patients (49.6%), not statistically different in those with earlier vs later EPOCC [n=9 (12.9%) vs 61 (87.1%), p=0.09]. Most common interventions included arch (n=9), atrial septum (n=9), collateral (n=9), and combination procedures (n=13). Complications of catheterization occurred in 10 patients (7%), not statistically different in the earlier vs later groups [n=6 (60% ) vs 4 (40%), p= 0.09]. Majority of complications were related to arrhythmia/ST segment depression, none included death or stroke. Patients with earlier EPOCC were statistically older (3 mos vs 1.5 mos, p=0.02) and weighed more (5.4kg vs 3.9kg, p=0.006) than those in the later EPOCC group. There were no statistically significant differences in median ICU length of stay (17.9d vs 28d, p=0.09), hospital length of stay (29.6d vs 49.9d, p=0.16), duration of mechanical ventilation (11.4d vs 13.4d, p=0.11) or duration of extracorporeal support (7.0d vs 15d, p=0.06) in the earlier vs later EPOCC groups. Discussion: The occurrence of complications related to EPOCC in our cohort was low, consistent with previously published work. While we did not demonstrate statistically significant differences in outcomes in patients who had catheterization performed earlier vs later after surgery, there is a trend towards significance with a higher number of catheter- based interventions, longer length of stay and duration of extracorporeal support in those patients who underwent later EPOCC. EPOCC appears to be safe when done < 72hours following surgery and we speculate that earlier catheterization may result in earlier intervention and a resultant decrease in extracorporeal support, ICU, and hospital length of stay. Our study is limited by the retrospective nature and small sample size. Further investigation is warranted.

Disciplines

Cardiology | Pediatrics

Notes

Presented at Cardiology 2022; Huntington Beach, California; August 30- September 3, 2022.

Safety, Timing, and Outcomes of Early Postoperative Cardiac Catheterization Following Congenital Heart Surgery

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