Author + information
- John W.M. Moore,
- Robert Vincent,
- Robert Beekman,
- Lisa Bergersen,
- Lee Benson,
- Ralf Holzer,
- Kathy Jenkins,
- Richard Ringel,
- Jonathan Rome,
- Kristina McCoy and
- Gerard Martin
The IMPACT registry captures data on cardiac catheterizations in patients with congenital heart disease. Since inception in January 2011, IMPACT participation has increased to 65 congenital heart centers which have submitted 8889 reports of catheterization. These reports include data specific to Aortic Valvuloplasty(AV) and Pulmonary Valvuloplasty (PV).
From July 2011 until June 2012, 6834 catheterizations met IMPACT Data Quality Guidelines. Among these, reports of AV and PV were reviewed including hemodynamic data, procedural characteristics, and adverse events (AE).
There were 105 (1.5%) AV; median length of stay (LOS) 1.0 day. Indications: gradient (86.7%), LV dysfunction (6.7%), symptoms (5.7%). Pre-procedure: median gradient was 60 mmHg; 1 or 2+ Al 91 (86.6%), > 2+ Al 7 (6.7%). AV performed in 97.1%. Single balloon used in 93.6%, stabilization in 74.3%. Post- procedure: gradient in single balloon: 40 in 29.0%; 1 or 2+ Al in 83.5%, >2+ Al 15.9%. AEs included arrhythmia in 8 (7.6%), requiring medication 1, cardioversion 2, pacemaker 2; bleeding or other events requiring transfusion 7 (6.7%); tamponade requiring drainage 1. Planned cardiac surgery performed in 3 patients; unplanned 1.
There were 243 (3.6%) PV; LOS 1 day. Indications: gradient (75.3%), RV dysfunction (11.1%), R to L shunting (7%), Symptoms (6.6%). Pre-procedure: median gradient was 47 mmHg, RVp/LVp 0.9. PV performed in 98.8%, Single balloon used in 95.1%, stabilization in 50.8%. Post-procedure: residual gradient in single balloon: 40 in 13.7%; 1 or 2+ PI 89.6%, >2+ PI 9.4%. AEs included arrhythmia in 11 (4.5%), requiring medication 7, cardioversion 2; bleeding or other events requiring transfusion 18 (7.5%); cardiac arrest 2, ECMO 2. Planned cardiac surgery in 11; unplanned 0.
Reported complication rates of AV are relatively low, but in many cases AV resulted in suboptimal gradient relief, (perhaps to avoid increasing Al). PV also has low reported complication rates and appears to have has better efficacy. Progression to > 2+ insufficiency was not a major problem in either group. There were no deaths reported.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Congenital Catheter Interventions
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1291-126
- 2013 American College of Cardiology Foundation