TY - JOUR
T1 - Outcomes and Risk Factors of Transcatheter Interventions to Create or Enlarge an Atrial Communication
AU - Holzer, Ralf J.
AU - Alnoor, Mohammad
AU - Aslam, Nadeem
AU - Blais, Benjamin
AU - Bocks, Martin
AU - Eilers, Lindsay
AU - Foerster, Susan
AU - Gauvreau, Kimberlee
AU - Kobayashi, Daisuke
AU - Nicholson, George
AU - Rahman, Grace
AU - Trucco, Sara M.
AU - Quinn, Brian
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025.
PY - 2025
Y1 - 2025
N2 - Despite interventions to enlarge/create an atrial communication having been performed for several decades, only a single larger multi-center study has reported procedural adverse events on at least 200 patients. Most studies have included associated interventions performed in the same setting and have not differentiated by procedural techniques, limiting the ability to derive conclusions from those reports. 432 cases from the C3PO-QI registry dataset from 01/2014 to 12/2017 who underwent interventions to enlarge/create an atrial communication were included (excluding patients with other interventions performed in the same setting). Patient- and procedure-specific data were analyzed, and risk factors for clinically meaningful adverse events (CMAE) were identified. 63% of interventions to enlarge/create an atrial communication were performed < = 30 days of age, 18% age 1–11 months, and 19% > = 1 year. 91% were non-elective procedures. For atrial access, 18% required needle or radiofrequency (RF) puncture. Balloon septostomy alone was performed in 73%, atrial septoplasty (± BAS) in 12%, and atrial stent or blade septostomy in 15%. CMAE occurred in 6.5% of cases (mortality 2%). By multivariable analysis, risk factors for CMAE were single ventricle and atrial needle or RF puncture. When analyzing neonates and patients one year of age or older separately, pre-procedural ECMO, single-ventricle physiology, atrial access via needle or RF puncture, and type of atrial intervention other than standard BAS, were all associated with an increased incidence of CMAE in neonates, but not in patients 1 year of age or older. Interventions to enlarge/create an atrial communication carry a risk of CMAE that varies by age group, with ECMO at the start, single-ventricle physiology, atrial access via needle or RF puncture, and type of atrial intervention anything other than standard BAS being significant risk factors for CMAE in neonates, but not in patients above 1 year of age.
AB - Despite interventions to enlarge/create an atrial communication having been performed for several decades, only a single larger multi-center study has reported procedural adverse events on at least 200 patients. Most studies have included associated interventions performed in the same setting and have not differentiated by procedural techniques, limiting the ability to derive conclusions from those reports. 432 cases from the C3PO-QI registry dataset from 01/2014 to 12/2017 who underwent interventions to enlarge/create an atrial communication were included (excluding patients with other interventions performed in the same setting). Patient- and procedure-specific data were analyzed, and risk factors for clinically meaningful adverse events (CMAE) were identified. 63% of interventions to enlarge/create an atrial communication were performed < = 30 days of age, 18% age 1–11 months, and 19% > = 1 year. 91% were non-elective procedures. For atrial access, 18% required needle or radiofrequency (RF) puncture. Balloon septostomy alone was performed in 73%, atrial septoplasty (± BAS) in 12%, and atrial stent or blade septostomy in 15%. CMAE occurred in 6.5% of cases (mortality 2%). By multivariable analysis, risk factors for CMAE were single ventricle and atrial needle or RF puncture. When analyzing neonates and patients one year of age or older separately, pre-procedural ECMO, single-ventricle physiology, atrial access via needle or RF puncture, and type of atrial intervention other than standard BAS, were all associated with an increased incidence of CMAE in neonates, but not in patients 1 year of age or older. Interventions to enlarge/create an atrial communication carry a risk of CMAE that varies by age group, with ECMO at the start, single-ventricle physiology, atrial access via needle or RF puncture, and type of atrial intervention anything other than standard BAS being significant risk factors for CMAE in neonates, but not in patients above 1 year of age.
KW - Adverse events
KW - Cardiac catheterization
KW - Congenital heart disease
KW - Length of stay
UR - https://www.scopus.com/pages/publications/105019070853
U2 - 10.1007/s00246-025-04061-7
DO - 10.1007/s00246-025-04061-7
M3 - Article
C2 - 41107484
AN - SCOPUS:105019070853
SN - 0172-0643
JO - Pediatric Cardiology
JF - Pediatric Cardiology
ER -