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Mbabazi N, Aliku T, Namuyonga J, Tumwebaze H, Ndagire E, Obongonyinge B, Khainza RE, Akech MT, Angelline K, Nakato A, Ssendagire C, Ssemogerere L, Oketcho M, Omagino J, Lwabi P, Lubega S. Congenital heart disease cardiac catheterization at Uganda Heart Institute, a 12-year retrospective study of immediate outcomes. BMC Cardiovasc Disord 2024; 24:463. [PMID: 39210275 PMCID: PMC11360719 DOI: 10.1186/s12872-024-04085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Cardiac catheterization is an invasive diagnostic and treatment tool for congenital heart disease (CHD) with potential complications. OBJECTIVE To describe the immediate outcomes of patients who underwent cardiac catheterization for CHD at the Uganda Heart Institute (UHI). METHODS The study was a retrospective chart review of 857 patients who underwent cardiac catheterization for CHD at UHI from 1st February 2012 to 30th June 2023. Precardiac catheterization clinical data, procedure details, and post-procedure data were recorded. The statistical software SPSS was used for data analysis. RESULTS We studied 857 patients who underwent cardiac catheterization for CHD at UHI. Females comprised 62.8% (n = 528). The age range was 3 days to 64 years, with a mean of 5.1 years (SD 7.4). Advanced heart failure was present in 24(2.8%) of the study participants. The most common procedures were patent ductus arteriosus device closure (n = 500, 58.3%), diagnostic catheterization (n = 194, 22.5%), and balloon pulmonary valvuloplasty (n = 114, 13.0%). PDA device closure had 89.4% optimal results while BPV had 75.9% optimal performance outcome. Adverse events occurred in 52 out of 857 study participants (6.1%). Clinically meaningful adverse events (CMAES) occurred in 3.9%, (n = 33), high severity adverse events in 2.9% (n = 25) and mortality in 1.5% (n = 13). Advanced heart failure at the time of cardiac catheterization, was significantly associated with clinically meaningful adverse events (OR 52 p-value < 0.001) and mortality (OR 564, p value < 0.001). CONCLUSION Many patients with CHD have benefited from the cardiac catheterization program at UHI with high optimal procedure outcome results. Patients with advanced heart failure at the time of cardiac catheterization have less favorable outcomes emphasizing the need for early detection and early intervention.
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Affiliation(s)
- Nestor Mbabazi
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda.
- Mulago National Referral Hospital, Kampala, Uganda.
| | - Twalib Aliku
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Uganda Christian University School of Medicine, Mukono, Uganda
| | - Judith Namuyonga
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Emma Ndagire
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
| | | | - Rebecca Esther Khainza
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Mulago National Referral Hospital, Kampala, Uganda
| | | | - Killen Angelline
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- John. Fitzgerald Kennedy Hospital, 22nd Street Sinkor, Monrovia, Liberia
| | - Aisha Nakato
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Bombo General Military Hospital, Bombo, Uganda
| | - Cornelius Ssendagire
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Lameck Ssemogerere
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - John Omagino
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
| | - Peter Lwabi
- Uganda Heart Institute, P.O. Box 3792, Kampala, Uganda
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101181. [PMID: 39131968 PMCID: PMC11307799 DOI: 10.1016/j.jscai.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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Hasan BS, Barry OM, Ali F, Armstrong AK, Batlivala SP, Crystal MA, Divekar A, Gudausky T, Holzer R, Kreutzer J, Nicholson G, O’Byrne ML, Quinn BP, Boe BA. Evaluating Procedural Performance: A Composite Outcome for Aortic and Pulmonary Valvuloplasty in Congenital Cardiac Catheterization. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101119. [PMID: 39129900 PMCID: PMC11308845 DOI: 10.1016/j.jscai.2023.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2024]
Abstract
Background Safety events and technical success (TS) have been previously reported for aortic and pulmonary valvuloplasty, but a composite performance measure as a novel, patient-centered strategy has neither been developed nor been studied. This study aims to refine a procedural performance (PP) variable, a composite of TS and procedural safety, for isolated, standard-risk aortic and pulmonary valvuloplasty. Methods A multicenter review was performed using data from the Congenital Cardiac Catheterization Project on Outcomes registry. Data were collected for all cases of isolated balloon aortic and pulmonary valvuloplasty from 2014 through 2017. Patients were excluded if they were aged <1 month, were inpatient at the time of the procedure, or had significant comorbidities, such as Williams or Noonan syndrome. Criteria for TS were developed and categorized (optimal, satisfactory, and unsatisfactory) by expert consensus based on previous outcome research. Adverse events (AE) were categorized by severity (level 1-5) using established criteria. Level 4 and 5 severity AE were considered high-severity AE. Using criteria of TS and AE severity, PP was divided into 3 composite outcome classes. Factors correlating with class III (suboptimal) PP were analyzed. Results There were 169 cases of aortic and 270 cases of pulmonary valvuloplasty in the cohorts. In the aortic valvuloplasty cohort, a suboptimal PP (class III) occurred in 14% of cases, mostly due to high-severity AE (7%). No significant correlation between patient or case characteristics and PP was demonstrated. In the pulmonary valvuloplasty cohort, class III PP occurred in 9% of cases, predominantly due to residual valve gradient, which correlated with lower weight (P = .02). Conclusions We designed a composite variable of PP consisting of TS and safety as a comprehensive measure of outcome. Incorporating both TS and AE may better reflect patient outcome than each metric measured separately. PP indices may identify areas for further investigation and quality improvement.
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Affiliation(s)
- Babar S. Hasan
- Division of Cardio-thoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Oliver M. Barry
- Division of Cardiology, Morgan Stanley Children’s Hospital of New York and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Fatima Ali
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Aimee K. Armstrong
- The Heart Center, Nationwide Children’s Hospital and Department of Pediatrics Ohio State University School of Medicine, Columbus, Ohio
| | - Sarosh P. Batlivala
- Department of Pediatrics, University of Cincinnati College of Medicine and Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Matthew A. Crystal
- Division of Cardiology, Morgan Stanley Children’s Hospital of New York and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Abhay Divekar
- Division of Pediatric Cardiology, UT Southwestern Medical Center, Dallas Children’s Hospital, Dallas, Texas
| | - Todd Gudausky
- Division of Pediatric Cardiology, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ralf Holzer
- Department of Pediatrics, UC Davis Medical Center, UC Davis Children’s Hospital, Sacramento, California
| | - Jacqueline Kreutzer
- Division of Cardiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - George Nicholson
- Division of Cardiology, Monroe Carell Jr. Children’s Hospital and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael L. O’Byrne
- Division of Cardiology and Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P. Quinn
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Brian A. Boe
- Department of Cardiology, Joe DiMaggio Children’s Hospital, Hollywood, Florida
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Ali F, Yeh MJ, Bergersen L, Gauvreau K, Polivenok I, Ronderos M, De Decker R, Kumar RK, Jenkins K, Hasan BS. Congenital Cardiac Catheterization in Low- and Middle-Income Countries: The International Quality Improvement Collaborative Catheterization Registry. JACC. ADVANCES 2023; 2:100344. [PMID: 38938241 PMCID: PMC11198277 DOI: 10.1016/j.jacadv.2023.100344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 06/29/2024]
Abstract
Background No published data are available on the patient, procedural characteristics, and outcomes of congenital heart disease (CHD) cardiac catheterization performed in low- and middle-income countries (LMICs). Objectives The objective of this study was to describe procedural characteristics and patient outcomes of CHD cardiac catheterizations in LMICs. Methods Cases performed between January 2019 and December 2020 from 15 centers in the International Quality Improvement Collaborative Congenital Heart Disease Catheterization Registry (IQIC-CHDCR) data were included. The Procedural Risk in Congenital Cardiac Catheterization (PREDIC3T) classification was used to stratify risk. Outcomes of interest included mortality, severe adverse events (SAEs), and procedural efficacy. Procedural efficacy, based on technical and safety endpoints, was categorized into optimal, adequate, and inadequate for 5 common interventional procedures. Results There were 3,287 cases, of which 60% (n = 1,973) were interventional cases. Most of the cases (66%) were in patients between the ages of 1 to 18 years with a median patient age of 4 years. PREDIC3T risk class 1 and 2 were most common in 37% and 38% of cases, respectively. SAEs occurred in 2.8% while the death was reported within <72 hours post catheterization 1%. The majority of device implantation procedures patent ductus arteriosus (67%) and atrial septal defect (60%) had optimal procedure efficacy outcomes. Conclusions This study demonstrates that congenital cardiac catheterization is safely performed in LMICs. Future work addressing predictors of SAEs and adverse procedural outcomes may help future quality improvement initiatives.
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Affiliation(s)
- Fatima Ali
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Mary J. Yeh
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Lisa Bergersen
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Igor Polivenok
- Zaitcev Institute for General and Urgent Surgery in Kharkov, Ukraine/Novick Cardiac Alliance, Kharkov, Sloboda, Ukraine
| | - Miguel Ronderos
- Fundación Cardioinfantil de Bogota, Institut of Congnitas Heart Disease, Bogota, Colombia
| | - Rik De Decker
- Division of Cardiology, Red Cross War Memorial Children’s Hospital in Cape Town, Cape Town, South Africa
| | - Raman Krishna Kumar
- Amrita Institute for Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Kathy Jenkins
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Babar Sultan Hasan
- Division of Cardio-thoracic Sciences, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Sindh, Pakistan
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