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Original research
Cardiac catheter intervention complexity and safety outcomes in adult congenital heart disease
  1. Margarita Brida1,2,3,
  2. Gerhard Paul Diller1,4,
  3. Heba Nashat1,
  4. Rosaria Barracano1,
  5. Aleksander Kempny1,3,
  6. Anselm Uebing1,
  7. Michael L Rigby1,
  8. Michael A Gatzoulis1,3
  1. 1Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
  2. 2Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia
  3. 3National Heart and Lung Institute, Imperial College London, London, UK
  4. 4Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany
  1. Correspondence to Dr Margarita Brida, Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London SW3 6NP, UK; margarita.brida{at}icloud.com

Abstract

Objective To describe the intervention spectrum, complexity, and safety outcomes of catheter-based interventions in a contemporary adult congenital heart disease (ACHD) tertiary cohort.

Methods All patients over 16 years who underwent a catheter-based intervention for ACHD in our centre between 2000 and 2016 were included. Baseline demographics, clinical characteristics, indications for and complexity of intervention, procedural complications and early and mid-term mortality were analysed.

Results Overall, 1644 catheter-based interventions were performed. Intervention complexity ranged from simple (67.5%) to intermediate (26.4%) and to high (6.1%). Commonly performed procedures were atrial septal defect (33.4%) and patent foramen ovale closure (26.1%) followed by coarctation of the aorta (11.1%) and pulmonary artery interventions (7.0%). Age at index intervention was 40±16 years, 758 (46.1%) patients were male, 73.2% in New York Heart Association (NYHA) class I, 20.2% in NYHA class II, whereas 6.6% in NYHA class III/IV. In-hospital mortality was 0.7%. Median postinterventional length of stay was 1 day. Complications occurred in 129 (7.9%) with major adverse events in 21 (1.3%). One-year postintervention survival rates were 98.7% (95% CI 98.2 to 99.2). Over the study period, there was a notable shift in intervention complexity, with a predominance of simple procedures performed in early years and more complex procedures in later years. Furthermore, the case mix during the study broadened (p<0.001) with new catheter-based interventions and a more individualised approach to therapy.

Conclusion This study shows an increasing complexity and expanding variability of ACHD catheter-based interventions, associated with low major complications, short hospital stays and low early and mid-term mortality. Ongoing investment in ACHD catheter interventions is warranted.

  • interventional cardiology and endovascular procedures
  • congenital heart disease
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Footnotes

  • Contributors MB and MAG planned and conducted the study. GPD, AK, HN, RB, AU and MLR made substantial contributions to conception and design, analysis and interpretation of data. MB and MAG made substantial contribution in analysis, drafting the article and revising it critically for important intellectual content. MB is responsible for the overall content as guarantor. All authors gave final approval of the version to be submitted and any revised version.

  • Funding MB was a recipient of research grant from the EMAH Stiftung Karla Voellm, Krefeld, Germany. GPD, AK, MAG, AU, HN and the Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK have received support from Actelion UK, Pfizer UK, GSK UK, the British Heart Foundation and the NIHR Cardiovascular and Respiratory Biomedical Research Units.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institutional Research and Governance Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article. Data were collected from the routine clinical care and administrative purposes in our hospital.

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