Procedural Risk in Congenital Cardiac Catheterization (PREDIC ³ T)

Abstract

Background Advancements in the field, including novel procedures and multiple interventions, require an updated approach to accurately assess patient risk. This study aims to modernize patient hemodynamic and procedural risk classification through the creation of risk assessment tools to be used in congenital cardiac catheterization. Methods and Results Data were collected for all cases performed at sites participating in the C3PO (Congenital Cardiac Catheterization Project on Outcomes) multicenter registry. Between January 2014 and December 2017, 23 119 cases were recorded in 13 participating institutions, of which 88% of patients were <18 years of age and 25% <1 year of age; a high‐severity adverse event occurred in 1193 (5.2%). Case types were defined by procedure(s) performed and grouped on the basis of association with the outcome, high‐severity adverse event. Thirty‐four unique case types were determined and stratified into 6 risk categories. Six hemodynamic indicator variables were empirically assessed, and a novel hemodynamic vulnerability score was determined by the frequency of high‐severity adverse events. In a multivariable model, case‐type risk category (odds ratios for category: 0=0.46, 1=1.00, 2=1.40, 3=2.68, 4=3.64, and 5=5.25; all P ≤0.005) and hemodynamic vulnerability score (odds ratio for score: 0=1.00, 1=1.27, 2=1.89, and ≥3=2.03; all P ≤0.006) remained independent predictors of patient risk. Conclusions These case‐type risk categories and the weighted hemodynamic vulnerability score both serve as independent predictors of patient risk for high‐severity adverse events. This contemporary procedure‐type risk metric and weighted hemodynamic vulnerability score will improve our understanding of patient and procedural outcomes.

German Registry for Cardiac Operations and Interventions in Patients with Congenital Heart Disease: Report 2021 and 9 Years' Longitudinal Observations on Fallot and Coarctation Patients

“…However, this has to be carefully interpreted with the given limitations of data acquisition and with respect to the fact that we only report observed mortality and morbidity and did not compare with calculated expected mortality and morbidity rates. [27][28][29] As expected, mortality was highest after Norwood I procedures. 30 These patients carried the largest morbidity burden as well, which was expressed by all key performance indicators (►Table 2).…”

Anesthesia management of interventional cardiac catheterization for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS): a retrospective analysis

“…Among the procedural risks of congenital cardiac catheterization, neonatal atretic valve perforation with or without valvuloplasty is at level 5, which is the most dangerous level [7]. In addition to the potential risks associated with the intervention itself, PA/IVS and CPS newborns are characterized by low age, low weight, cyanosis, pulmonary hypertension, and low cardiac output.…”

Changes in Practice/Outcomes of Pediatric/Congenital Catheterization in Response to the First Wave of COVID

“…Outcomes collected were AEs as well as unplanned admission and death at ≤72 hours of catheterization procedure. AEs are stratified in the current version of C3PO using Strata (Stratacorp) similar to those described for previous iterations, 8 , 9 , 10 , 11 specifically stratified into 5 levels of increasing severity. A change in the most recent iteration is division of level 3 events between 3a events and more severe 3bc events.…”

“…Potential covariates were identified from previous studies in large registries and databases after adjusting for case-mix 8 , 9 , 12 , 13 , 14 , 15 , 16 and extracted covariates were cardiothoracic surgery in the preceding 90 days, noncardiac medical conditions (coagulation disorder, renal insufficiency, and other), single ventricular vs biventricular circulation, indicators of hemodynamic vulnerability (elevated systemic ventricular end-diastolic pressure, low mixed venous saturation, low systemic arterial saturation, elevated pulmonary pressure, and elevated indexed pulmonary vascular resistance), 8 preprocedural cardiac status (a novel ordinal marker of preprocedural risk developed at the Boston Children’s Hospital), and Procedure Risk in Congenital Cardiac Catheterization (PREDIC 3 T) case types. 9 This panel of covariates includes measures (eg, PREDIC 3 T case type and cardiac status) that have been identified since the previous C3PO risk adjustment models and are included in the hopes of providing the most accurate depiction of risk in this cohort. Age of patients was divided into neonates (≤30 days), infants (>30 days and <1 year), children (≥1 year and <18 years), and adults (≥18 years) as described previously.…”