Indications and outcomes of cardiac catheterization following congenital heart surgery in children.

Objectives: Our goal was to evaluate the indications for postoperative cardiac catheterizations after paediatric cardiac surgeries and their impact on outcomes.

Methods: Non-planned cardiac catheterizations performed after congenital heart surgeries and before discharge between January 2013 and July 2019 were reviewed. Hybrid procedures were excluded. Heart defects, illness course, surgeries and catheter procedures were classified. Indications and findings were comprehensively regrouped. Outcomes were analysed.

Results: Cardiac catheterizations were performed on 192 patients (median age 2.3 months, weight 4.2 kg) on median postoperative day 7 (interquartile range, 2-17 days). Patients had defects of great complexity (79.9%), high disease severity index (46.4%), high Aristotle level of surgical complexity (75%) and a high Catheterization RISk Score for Pediatrics category of catheterizations (61%). Catheterizations confirmed 66% of suspected diagnoses. Confirmed diagnoses were more likely to be haemodynamic anomalies than anatomical lesions (81.3% > 53.7%, P < 0.001). Confirmed anatomical lesions were more likely to be residual than new lesions created by surgery (88.5% > 40.4%, P < 0.001). New diagnoses were identified in 36.5% of patients. Catheterization findings led to catheter-based or surgical interventions in 120 (62.5%) patients. Transcatheter interventions were successful (97.7%), immediate (89.5%) and performed across fresh suture lines (27.8%). Repeat catheterizations (76% interventional) were necessary in 25 (13%) patients. A high index of disease severity [odds ratio (OR): 16.26, 95% confidence interval (CI): 3.72-71.17], extracorporeal membrane oxygenation support (OR: 10.35, 95% CI: 2.78-38.56), delayed sternal closure (OR: 4.66, 95% CI: 1.25-17.32) and surgically acquired lesions (OR: 3.70, 95% CI: 1.22-11.16) were significant risk factors of 12-month mortality.

Conclusions: Postoperative cardiac catheterizations answer both anatomical and haemodynamic questions in high-risk patients with complicated courses and guide subsequent treatment with satisfactory outcomes.