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PubMed1994

Use of a mechanical pressure device for hemostasis following cardiac catheterization.

BACKGROUND: Peripheral vascular complications that can occur after cardiac catheterization are costly and cause patient discomfort. OBJECTIVES: To determine the difference in frequency of vascular complications in a convenience sample of cardiac catheterization patients who had mechanical pressure vs digital pressure for postprocedural hemostasis. METHODS: A quasi-experimental design was used. The study group consisted of 100 patients on whom a mechanical clamp was used to effect hemostasis; the control group consisted of 100 patients who received digital pressure for hemostasis. Data from the control group were obtained retrospectively through review of cardiac catheterization charts. RESULTS: The two groups showed statistically significant differences for the number of catheters used, mean time elapsed between arterial entry and catheter removal, and compression time. There was no significant difference in complication rate between the groups. DISCUSSION: Complications including hematoma formation, arterial occlusion, ischemia and traumatic neuropathy were monitored. CONCLUSIONS: The mechanical pressure device is a safe, cost-effective alternative to digital pressure for hemostasis following cardiac catheterization. Further studies are needed to verify these results and the effectiveness of the device following other percutaneous intra-arterial procedures.

Cardiac Catheterization↗
PubMed2002

Interventions in pediatric cardiac catheterization.

Since its inception in 1929, cardiac catheterization has undergone many changes. In the last two decades we have seen an evolution in cardiac catheterization from a diagnostic (anatomic and physiologic) to a therapeutic modality. This article highlights some of the more common and newer interventional procedures now performed.

Angioplasty, Balloon, Coronary↗
PubMed2005

Population rates of cardiac catheterization and yield of high-risk coronary artery disease.

BACKGROUND: The optimal population rate of cardiac catheterization is unknown. One potential way to determine it would be to examine whether there is a population rate beyond which the yield of high-risk coronary artery disease (CAD) does not rise. METHODS: Using a detailed clinical registry that captures all patients undergoing cardiac catheterization in Alberta, we determined annual population rates of cardiac catheterization and the corresponding yield of cases of high-risk CAD in each of Alberta's 17 health regions from 1995 to 2002. Least squares linear regression analysis and hierarchical modelling methods were then used to assess the linear relation between catheterization rates and rates of high-risk CAD. RESULTS: The age-adjusted average rate of cardiac catheterization among men ranged from 404.9 to 638.1 per 100,000 population aged over 20 years. Among women, the average rate ranged from 171.8 to 314.0 per 100,000. For both sexes, increased regional rates of catheterization were associated with a linearly increasing yield of high-risk CAD, with no evidence of a plateau in yield when more procedures were performed. One additional case of high-risk CAD was identified for every 2.5 additional cardiac catheterization procedures performed among men, and for every 3.7 additional procedures performed among women. INTERPRETATION: The increasing yield of patients with high-risk CAD associated with increased regional population rates of cardiac catheterization, together with the absence of a plateau in yield, suggests that Alberta's population rates of cardiac catheterization are suboptimal to detect people with high-risk CAD.

Adult↗
PubMedDate not supplied

Outpatient cardiac catheterization: its role in managed care.

Cardiac catheterization, as developed by Dr. Sones, has revolutionized the practice of ischemic heart disease. I personally appreciate his support on behalf of the development of outpatient cardiac catheterization, as he counseled me over the years in regards to this methodology. I believe its appropriate use, both in certified ambulatory facilities as well as in expanded hospital programs, would lower the death rate in those who experience sudden death as well as myocardial infarction. Cardiovascular administrators must now position themselves in the outpatient area in order to coordinate not only outpatient catheterization, but also noninvasive assessment. They also must provide support for managed care, which utilizes low-cost programs such as: outpatient cardiac rehabilitation for drug selection, assessment of ischemia, appropriate management (rather than relying on sudden death and myocardial infarction as a satisfactory method of identifying patients with heart disease).

Ambulatory Surgical Procedures↗
PubMed2006

[Cardiac catheterization in neonates: experience in 26 neonates].

Cardiac catheterization is rarely performed in neonates in China. The medical records of 26 neonates who underwent cardiac catheterization in Shanghai Children's Medical Center from June 1994 to June 2004 were reviewed. These infants weighed 2300 to 4500 g (mean 3 400 +/- 500 g). Postnatal age ranged from 5 to 28 days (mean 15.2 +/- 8.7 days). Right heart ventricle angiography was performed in 24 cases, left heart ventricle angiography in 20 cases and pulmonary angiography in 6 cases. Balloon aortic septostomy (BAS) was performed in 10 cases. Twenty cases were diagnosed with complex cyanotic cardiovascular malformations and 4 with acyanotic heart disease. The implantation of a temporary cardiac pacemaker was performed in 2 cases. All diagnostic and interventional procedures were successfully performed. The catheterization-related complications occurred in 15.3% of the 26 cases, but without mortality. In conclusion, cardiac catheterization is an accurate and safe method for diagnosing complex congenital heart diseases in neonates. Interventional catheterization is useful in the treatment of complex congenital heart malformations.

Cardiac Catheterization↗
PubMed2002

Sex differences in cardiac catheterization after acute myocardial infarction: the role of procedure appropriateness.

BACKGROUND: Many studies have found that women are less likely than men to have cardiac catheterization after an acute myocardial infarction; however, it is unknown whether sex differences reflect inappropriate treatment. OBJECTIVE: To ascertain whether cardiac catheterization use after acute myocardial infarction in men and women varied by sex and the appropriateness of the procedure, as determined by clinical guidelines. DESIGN: Retrospective analysis of chart-abstracted data. SETTING: U.S. acute-care hospitals. PATIENTS: 143 444 Medicare patients who were hospitalized for acute myocardial infarction between 1994 and 1996. MEASUREMENTS: Cardiac catheterization use within 60 days of hospitalization for acute myocardial infarction. RESULTS: Women had lower crude rates of cardiac catheterization than men (35.7% for women vs. 46.5% for men [ P < 0.001]; difference, 10.8 percentage points). Multivariable adjustment for demographic, clinical, and hospital characteristics reduced most of the sex differences in procedure use (risk-standardized rates, 40.3% for women vs. 41.9% for men [ P < 0.001]; difference, 1.6 percentage points). Sex differences in cardiac catheterization use varied by the appropriateness of the procedure. Risk-standardized rates of cardiac catheterization were similar for men and women with strong indications for the procedure (44.1% for women vs. 44.6% for men [ P > 0.2]; difference, 0.5 percentage point). Rates of cardiac catheterization use among patients with weak indications did not significantly differ between men and women (16.5% for women vs. 18.0% for men [ P = 0.096]; difference, 1.5 percentage points). Sex differences in cardiac catheterization use were largest for patients with equivocal indications (39.4% for women vs. 42.5% for men [ P < 0.001]; difference, 3.1 percentage points). CONCLUSIONS: Among elderly persons, women have lower rates of cardiac catheterization use after an acute myocardial infarction than men. However, this difference was attenuated after multivariable adjustment, and it occurred primarily in patients with equivocal indications. We found no sex variations in procedure use among patients who had strong indications for cardiac catheterization.

Aged↗
PubMed2003

A prospective study on incidence and risk factors of arteriovenous fistulae following transfemoral cardiac catheterization.

BACKGROUND: A potentially harmful complication of cardiac catheterization is the arteriovenous fistula. Precise knowledge of possible factors predisposing for acquisition of iatrogenic AV-fistulae could enable cardiologists to perform a risk stratification for cardiac patients prior to catheterization. METHODS: Over a period of 2 years, 10,271 consecutive patients who underwent cardiac catheterization were included in this study. Auscultation of a new femoral bruit was followed by a duplex scan to confirm the suspected diagnosis of an AVF. Every patient was investigated on the day after catheterization. RESULTS: The incidence of iatrogenic AVF was 0.86%. A multivariate regression analysis revealed five significant and independent risk factors: (1) procedural heparin dosage >or=12,500 IU (Odds Ratio (OR)=2.88), (2) coumadin therapy (OR=2.34), (3) puncture of the left groin (OR=2.21), (4) arterial hypertension (OR=1.86) and (5) female gender (OR=1.84). Coronary angioplasty (instead of diagnostic procedure), size and number of sheaths, age and body mass index did not significantly affect the incidence of AVF. CONCLUSIONS: The overall incidence of AV-fistulae following cardiac catheterization approximates 1%. Determination of significant risk factors will facilitate identification of patients at risk for iatrogenic arteriovenous fistulae prior to cardiac catheterization and thus help to develop strategies to reduce the incidence of AV-fistulae.

Aged↗
PubMed2006

The ALARA concept in pediatric cardiac catheterization: techniques and tactics for managing radiation dose.

The cardiac catheterization laboratory plays an important role in the management of children with congenital heart disease by not only enabling diagnosis but, in many cases, providing definitive therapy. The goal of the ALARA (As Low as Reasonably Achievable) concept as it applies to cardiac catheterization is to provide maximal diagnostic and therapeutic benefit while requiring the lowest possible radiation dose. A number of specific challenges unique to the setting of pediatric cardiac catheterization, such as higher heart rates, smaller cardiovascular structures, smaller body size, and wider variety of unusual anatomic variants with the potential need for relatively lengthy and complex studies, result in relatively high radiation doses (to the patient and, consequently, to laboratory personnel). In addition, the improved survival of patients with complex anatomy (e.g., palliated single ventricle anatomies) implies that many such children with chronic cardiac disease require frequent catheterizations within the first few years of life. These factors, coupled with the increased radiosensitivity of children and a longer lifespan ahead of them in which to possibly develop radiation-related sequelae, converge to create potentially ominous consequences. Attention to basic rules of radiation safety is, therefore, of tremendous importance in the pediatric cardiac catheterization laboratory. This review focuses on the importance of adequate planning of the study, optimizing image formation, management of fluoroscopy and cine angiography parameters, and the use of certain equipment features that might allow the cardiologist to lower the radiation dose without sacrificing image quality.

Body Burden↗
PubMed2006

Infection control guidelines for the cardiac catheterization laboratory: society guidelines revisited.

In the early years of diagnostic cardiac catheterization, strict sterile precautions were required for cutdown procedures. Thirteen years ago, when the original guidelines were written, the brachial arteriotomy was still frequently utilized, femoral closure devices were uncommon, "implantables," such as intracoronary stents and PFO/ASD closure devices, were in their infancy, and percutaneous valve replacement was not a consideration. In 2005, the cardiac catheterization laboratory is a complex interventional suite with percutaneous access routine and device implantation standard. Despite frequent device implantation, strict sterile precautions are often not observed. Reasons for this include a decline in brachial artery cutdown, limited postprocedure follow-up with few reported infections, limited use of hats and masks in televised cases, and lack of current guidelines. Proper sterile technique has the potential to decrease the patient infection rate. Hand washing remains the most important procedure for preventing infections. Caps, masks, gowns, and gloves help to protect the patient by maintaining a sterile field. Protection of personnel may be accomplished by proper gowning, gloving, and eye wear, disposal of contaminated equipment, and prevention and care of puncture wounds and lacerations. With the potential for acquired disease from blood-borne pathogens, the need for protective measures is as essential in the cardiac catheterization laboratory as is the standard Universal Precautions, which are applied throughout the hospital. All personnel should strongly consider vaccination for hepatitis B. Maintenance of the cardiac catheterization laboratory environment includes appropriate cleaning, limitation of traffic, and adequate ventilation. In an SCAI survey, members recommended an update on guidelines for infection control in the cardiac catheterization laboratory. The following revision of the original 1992 guidelines is written specifically to address the increased utilization of the catheterization laboratory as an interventional suite with device implantation. In this update, infection protection is divided into sections on the patient, the laboratory personnel, and the laboratory environment. Additionally, specific CDC recommendation sections highlight recommendations from other published guidelines.

Antibiotic Prophylaxis↗
PubMed2000

Evaluation of a thoracic bioimpedance cardiac output monitor during cardiac catheterization.

OBJECTIVE: To evaluate the accuracy and precision of an advanced thoracic bioimpedance cardiac output monitor by comparing it with conventional thermodilution. DESIGN: Prospective data collected from 47 patients undergoing routine cardiac catheterization. The new bioimpedance system differs from its predecessors in electrode system configuration, advanced signal processing, use of a modified Kubicek equation, and a reliable estimate of left ventricular ejection time from the time derivative bioimpedance signals. SETTING: A cardiac catheterization laboratory in a university affiliated teaching hospital. PATIENTS: A series of 47 relatively homogenous patients undergoing routine cardiac catheterization for suspected cardiac disease. MEASUREMENTS AND MAIN RESULTS: The data from the first 20 patients was used to determine optimal values for coefficients in the bioimpedance cardiac output equations. The coefficients found were used when the system was tested in the subsequent 27 patients. For the last 27 patients, a total of 80 simultaneous pairs of cardiac output measurements were made by conventional thermodilution and by thoracic bioimpedance. The mean difference between the two methods was -0.31 L/min and the standard deviation of the differences was (0.76 L/min). The correlation coefficient was r2 = .72 (p < .001). CONCLUSIONS: The correlation between conventional thermodilution and thoracic bioimpedance cardiac output estimates was good and the standard deviation of the differences was lower than that reported for commercially available devices. The system can be used in the cardiac catheterization lab for reliable and continuous noninvasive measurement of cardiac output.

Cardiac Catheterization↗
PubMed1993

Multivariable model for prediction of risk of significant complication during diagnostic cardiac catheterization. The Registry Committee of the Society for Cardiac Angiography & Interventions.

Although adequate data exist on the frequency of procedural-related complications during diagnostic cardiac catheterization, little information is available for the quantitative assessment of risk factors for significant complication. We analyzed 58,332 procedures in the 1990 SCA&I Registry Database in order to assess 1) the independent and cumulative significance of easily obtainable pre-procedural factors predictive of major complication and 2) the likelihood of a significant complication given the presence of these risk factors. A model was developed on a random sample of 38,888 patients and validated in the remaining 19,444 patients. Twelve variables were identified as having independent predictive behavior for significant complication with excellent agreement in the validation sample. The current model is an accurate and reliable instrument for stratifying risk of a significant complication during diagnostic catheterization.

Aged↗
PubMed1996

Five year trends in cardiac catheterization: a report from the Registry of the Society for Cardiac Angiography and Interventions.

The Society for Cardiac Angiography and Interventions has maintained a registry of cardiac catheterizations since 1979 and of percutaneous cardiac interventions since 1990. Data from 392,923 procedures (317,592 diagnostic catheterizations, 74,963 coronary interventions, and 368 valvuloplasties) for the years 1990-1994 inclusive are presented. Over the 5 year period there was a trend toward same day and 23 hr discharges (19% in 1990 to 29% in 1994), and a decrease in combined right and left heart procedures from 38% to 26%. For cardiac catheterizations ionic contrast use declined from 26% of procedures to 13% in 1994. The use of ionic contrast was even lower in interventional procedures, with laboratories reporting use in 21% of procedures in 1990 dropping to 9% in 1994. Balloons were the first choice device in 92.5% of native arteries and 82.7% of grafts in 1994. For the first time in 1994 more mitral than aortic valvuloplasties were reported.

Angioplasty, Balloon, Coronary↗
PubMed1995

Effects of routine premedication for cardiac catheterization on sedation, level of anxiety and arterial oxygen saturation.

OBJECTIVE: To assess the efficacy and side effects of routine premedication in patients undergoing cardiac catheterization procedures in a tertiary cardiac care institute. The criteria used included: arterial hemoglobin oxygen saturation (%SaO2), level of sedation and level of anxiety before and after the procedure. Overall patient satisfaction was also quantified. DESIGN: Sixty-two adult patients scheduled for cardiac catheterization procedures were recruited for the study. They were premedicated with one of several premedication regimens: oral diazepam 5 to 10 mg; oral lorazepam 1 mg; oral diazepam 10 mg+oral promethazine 25 mg; or oral diazepam 10 mg+oral diphenhydramine 25 mg. No attempt was made to control the premedication the patients received; it was ordered by each patient's cardiologist according to personal preference. Patients underwent pulse oximetry and evaluation of sedation, anxiety and level of satisfaction before and after cardiac catheterization. RESULTS: All patients tested had values for mean precatheterization %SaO2 above 92%. No patient had postcatheterization %SaO2 readings below that defined as indicating clinically significant hypoxemia (%SaO2 less than 90%). Patients were awake or lightly sedated before and after cardiac catheterization. Thirteen per cent of patients suffered from high levels of anxiety before, and 16% during, cardiac catheterization. Twenty-three per cent of patients reported being dissatisfied with the premedication before, and 10% of patients reported being dissatisfied during, cardiac catheterization. CONCLUSIONS: Clinically significant hypoxemia and oversedation are not problems for most patients given the types and doses of precatheterization medication used in the study population. The premedication schedules followed in the study failed to provide satisfaction and anxiolysis in a significant number of those studied.

Aged↗
PubMed2002

Pulmonary hypertension in sickle cell disease: cardiac catheterization results and survival.

Few results on cardiac catheterization have been published for patients with sickle cell disease (SCD) with pulmonary hypertension (PHTN). Their survival once this complication develops is unknown. We analyzed hemodynamic data in 34 adult patients with SCD at right-sided cardiac catheterization and determined the relationship of PHTN to patient survival. In 20 patients with PHTN the average systolic, diastolic, and mean pulmonary artery pressures were 54.3, 25.2, and 36.0 mm Hg, respectively. For 14 patients with SCD without PHTN these values were 30.3, 11.7, and 17.8 mm Hg, respectively. The mean pulmonary capillary wedge pressure in patients with PHTN was higher than that in patients without PHTN (16.0 versus 10.6 mm Hg; P =.0091) even though echocardiography showed normal left ventricular systolic function. Cardiac output was high (8.6 L/min) for both groups of patients. The median postcatheterization follow-up was 23 months for patients with PHTN and 45 months for those without PHTN. Eleven patients (55%) with PHTN died compared to 3 (21%) patients without PHTN (chi(2) = 3.83; P =.0503). The mean pulmonary artery pressure had a significant inverse relationship with survival (Cox proportional hazards modeling). Each increase of 10 mm Hg in mean pulmonary artery pressure was associated with a 1.7-fold increase in the rate (hazards ratio) of death (95% CI = 1.1-2.7; P =.028). The median survival for patients with PHTN was 25.6 months, whereas for patients without PHTN the survival was still over 70% at the end of the 119-month observation period (P =.044, Breslow-Gehan log-rank test). Our findings suggest that PHTN in patients with SCD shortened their survival.

Adult↗
PubMed1986

Brachial artery injury after cardiac catheterization.

During a 3-year period, 12,158 cardiac catheterizations were performed via the brachial artery. During this same period, 106 patients were operated on for complications of brachial artery injury and/or thrombosis, an incidence of 0.9%. The indication for the cardiac catheterization was coronary artery disease in almost 92% of the patients. Early (less than 4 days) brachial artery repair was done in 90% of the patients. The operative findings were thrombosis (91%), intimal injury (54%), stenosis (13%), laceration and/or perforation (11%), and atherosclerotic plaque (6%). Because of vessel injury, localized resection was done in two thirds of the patients. Vascular continuity was obtained with axial reanastomosis in 45 patients and interposition vein graft in 26 patients. Primary lateral repair was performed in 23 patients (22%). Ninety-five percent (101 patients) had initial excellent results. Of the five patients who required reoperation, flow was restored in four patients. Thus, 99% of patients had restoration of a patent brachial artery. Contributing factors for brachial artery complications are "redo" catheterization, prolonged catheterization time, catheter change, brachial artery atherosclerosis, improper arteriotomy closure, experience of cardiologist, female patient, and failure to use heparin. Because of the unpredictability of ischemic symptoms occurring after brachial artery thrombosis, the need for bypass graft surgery when delayed, and the good results with early surgical intervention, early exploration of brachial artery complications after cardiac catheterization and appropriate repair are recommended.

Adult↗
PubMedDate not supplied

[Neurological complications of cardiac catheterization].

AIMS: To describe the neurological complications of cardiac catheterization, together with its risk factors and pathogenic mechanisms. METHOD: Over the past few years there has been a marked increase in the number of interventions involving cardiac catheterizations. For this very reason, we can expect a proportional rise in the number of complications. The incidence of neurological pathologies secondary to heart interventions oscillates between 0.01 and 0.4% of procedures performed. The most frequent clinical pictures are cerebrovascular disease, neuro ophthalmological syndromes and peripheral neuropathies, due to damage done to the median, femoral and lateral femoral cutaneous nerves, and to the lumbar plexus. The most usual mechanisms are cerebral ischemia originated by embolisms and direct compression of the peripheral nerves. Factors increasing the likelihood of complications are old age, the presence of classic vascular risk factors and, probably, the patient s being female. More risk is involved in mitral and aortic valvuloplasties and non elective revascularization procedures. The personal experience of the operator and the overall activity of the department of haemodynamics where the physician works are factors that are very closely linked to the incidence of complications. CONCLUSIONS: Knowledge about neurological illness secondary to cardiac catheterization and its mechanisms of production may allow us to identify higher risk patients, to develop protocols to prevent it and to apply early therapeutic measures.

Cardiac Catheterization↗
PubMed1994

Extracorporeal life support of neonates with congenital cardiac defects: techniques used during cardiac catheterization and surgery.

Neonatal patients with congenital cardiac defects require proper diagnosis often by cardiac catheterization before surgical repair. In our institution, patients whose echocardiograms reveal surgically correctable lesions, but who are severely decompensated, have been placed on Extracorporeal Life Support (ECLS) prior to catheterization or surgery. Subsequent management of ECLS and cardiopulmonary bypass (CPB) are dictated by the surgical procedure. Hypothermia can be utilized while on ECLS to facilitate low-flow CPB, or circulatory arrest. Total extracorporeal circulation may be performed with the ECLS circuit, or the patient may be transferred to a conventional CPB circuit during the procedure. If required, post surgical ECLS can be facilitated through prior cannulation. We have found pre-operative institution of ECLS, in the neonate with severe congenital cardiac defects, provides immediate control of hemodynamic and respiratory problems, lowers the risk of cardiac catheterization, and reduces the usage of blood products during surgery.

Cardiac Catheterization↗
PubMed2000

Procedural costs of digital vs. analog archiving of diagnostic cardiac catheterizations.

The use of digital technology in the cardiac catheterization laboratory is expanding at a rapid pace. The cost-effectiveness of this new technology is yet to be proven. The aims of this study were to determine the direct cost differences of digital versus analog media (CDs) for the storage of diagnostic cardiac catheterizations and to explore the factors influencing these differences. Procedural costs of all diagnostic angiograms (n = 109), from three physicians, performed in an analog catheterization laboratory (room A) and a digital catheterization laboratory (room C) were compared during a 9-month period. The mean procedural cost was higher in room A than in room C ($1,102 vs. $1,087, P < 0.001). This cost difference was eliminated when recording media costs were excluded from analysis ($1,079 vs. $1,080, P = 0.931). Therefore, we conclude there is a procedural cost savings in a cardiac catheterization room that uses digital CDs versus cineangiogram film as the archival media. Cathet. Cardiovasc. Intervent. 49:246-250, 2000.

Cardiac Catheterization↗