Abstract 17894: Variation in Management of Single Ventricle Patients Undergoing Elective Cardiac Catheterization: a Report from the Congenital Cardiac Catheterization Project on Outcomes (C3PO)
Introduction: Variation in management surrounding cardiac catheterization (cath) in patients with single ventricle (SV) heart disease has not been rigorously described and is necessary to inform future quality improvement efforts and evidence-based guideline development.
Objectives: To assess institutional variation in SV cath management.
Methods: Patient and procedural characteristics related to elective SV cath were collected prospectively from 8 centers using a web-based multicenter registry (Congenital Cardiac Catheterization Project on Outcomes). Non-elective cases, those performed <30 days from cardiac surgery, <30 days of age, or in infants receiving prostaglandin therapy were excluded. Cases were stratified by stage of SV palliation (pre-bidirectional cavopulmonary anastomosis (pre-BCPA), pre-Fontan and post-Fontan) for analysis. Institutional variation was assessed.
Results: Between 2/2007 and 6/2010, 1568 elective SV cath procedures met criteria for study inclusion, including 395 pre-BCPA, 611 pre-Fontan and 562 post-Fontan cases. Across institutions, interventional cases comprised 21-63% (median 39%, [IQR 28, 47]) of the pre-BCPA cohort, 50-83% (median 63%, [55, 72]) of the pre-Fontan cohort and 25-91% (median 71%, [54, 82]) of the post-Fontan cohort. Use of positive pressure ventilation varied from 6-100% (median 96%, [56, 100]) in the pre-BCPA cohort, 10-100% (median 99%, [50, 100]) in the pre-Fontan cohort and 0-100% (median 88%, [37, 93]) in the post-Fontan cohort. Adverse event (AE) rates ranged from 0-43% (median 18%, [9, 27]), 0-22% (median 9%, [2, 14]) and 0-19% (median 9%, [5, 17]) in the pre-BCPA, pre-Fontan and post-Fontan cohorts, respectively. Rates of blood transfusion, age at pre-BCPA catheterization, procedure and fluoroscopy times, contrast dose, and key hemodynamic measures (mean PA pressure, cardiac index, ventricular end diastolic pressure) also varied importantly across institutions in the cohorts.
Conclusions: Substantial variation exists in the management surrounding elective cath in SV patients at all stages of palliation. Standardizing management around evidence-based practices may improve outcomes and reduce AE rates for these high-risk children and adults.
Author Disclosures: B.H. Goldstein: Consultant/Advisory Board; Modest; W.L. Gore & Associates. Consultant/Advisory Board; Significant; St. Jude Medical. L.B. Armsby: None. S.M. Trucco: None. D. Porras: None. J.J. Murphy: None. S.R. Foerster: None. R.H. Beekman: Consultant/Advisory Board; Modest; St. Jude Medical. L. Bergersen: None.
- © 2014 by American Heart Association, Inc.