Consensus statement highlights best practices for cardiac catheterization in children
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Key takeaways:
- A joint statement outlines best practices for training and competency in cardiac catheterization for congenital heart disease.
- The document includes modifications for resource-limited environments.
A consensus statement outlines best practices and competencies for cardiac catheterization in pediatric patients and adults with congenital heart disease, reflecting an evolution in practice for patients with unique procedural requirements.
“Requirements for cardiac catheterization procedures in pediatric patients and patients with congenital heart disease differ greatly from adult coronary or structural interventions, with limited existing practice standard recommendations,” Ralf J. Holzer, MD, MSc, FACC, FSCAI, FPICS, professor of clinical pediatrics at University of California, Davis, and director of pediatric and congenital cardiac catheterization at UC Davis Children’s Hospital, and colleagues wrote in JACC: Cardiovascular Interventions. “Those standards that do exist are often overly broad and do not account for variations in practices across the globe. Consequently, this document outlines comprehensive best practice recommendations including modifications and adaptations for resource-limited environments and adult congenital heart disease patients.”
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The practice of cardiac catheterization in pediatric patients and adults with congenital heart disease has evolved significantly over the past 50 years, from a mainly diagnostic modality to one with a predominance of transcatheter interventions that complement — and sometimes replace — a surgical intervention, the researchers wrote. In 2021, an expert consensus update was published under the umbrella of the Society for Cardiovascular Angiography and Interventions without any section dedicated to patients with congenital heart disease, according to the statement authors.
“Notably, congenital heart disease patients have procedural requirements very different from those of adult patients who undergo coronary interventions or interventions for structural heart disease,” the researchers wrote. “They also have different requirements in almost all areas that affect the working of a pediatric/congenital cardiac catheterization lab: laboratory layout and equipment, staffing requirements, procedural competency and training, surgical backup, anesthesia and sedation, and many other important periprocedural aspects of care.”
The comprehensive statement provides recommendations for procedural training and competencies, with special considerations for adult patients with congenital heart disease and for physicians practicing in resource-limited environments. The document also highlights the setup for an ideal pediatric/congenital cardiac catheterization lab suite, facility requirements, and best practices for surgical backup and circulatory support, anesthesia and sedation.
The statement also provides guidance on X-ray imaging and radiation safety, quality and safety metrics, and best practices for pre-, intra- and postprocedural management, as well as recommendations for fetal intervention procedures and coronary interventions in pediatric patients.
“It is believed that this document will provide additional strength and support for congenital cardiologists to educate local/regional/national authorities as to what medical experts believe to be acceptable, and preferably ideal, care for these patients,” the researchers wrote. “The document will also form the basis for advocacy efforts urging those authorities to make the legislative, regulatory and policy changes needed to achieve this goal.”
The consensus statement was a joint effort from the Pediatric and Congenital Interventional Cardiovascular Society (PICS), the Association for European Paediatric and Congenital Cardiology (AEPC), the Asia-Pacific Pediatric Cardiac Society (APPCS), the Cardiac Society of Australia and New Zealand (CSANZ), SCAI and the Latin American Society of Interventional Cardiology (SOLACI). The statement is endorsed by the Congenital Cardiac Anesthesia Society (CCAS) and the American Association of Physicists in Medicine (AAPM).
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