Incidence, predictors and outcomes of cardiac perforation during paediatric cardiac catheterization: A retrospective observational study from the Congenital Cardiac Interventional Study Consortium (CCISC)

Introduction: Cardiac perforation is a rare life-threatening complication of cardiac catheterization. There is very little published literature detailing risk factors for cardiac perforation and outcomes from this complication in children. Materials: and Methods This was a retrospective study analyzing the cardiac catheterization case registry of the Congenital Cardiovascular Interventional Study Consortium. Children aged <18 years were included during the study period of 9 years (January 2009- December 2017). The primary outcome measures were incidence of cardiac perforation, risk factors for and outcomes of patients who experience cardiac perforation during cardiac catheterization. Results: Cardiac perforation occurred in 50 patients from a total of 36,986 (0.14%). Cardiac perforation was more likely to occur in younger, smaller patients undergoing urgent /emergent and interventional procedures ( p <0.01). Cardiac peroration risk was significantly different across diagnostic and procedure categories ( p <0.01). Higher CRISP score (Area Under Curve [AUC] =0.87), lower age and procedure category (radio-frequency perforation of pulmonary valve, AUC =0.84) were independent predictors of cardiac perforation. Cardiac perforation was associated with a significantly higher rate of mortality (14%), further emergency procedure (42%), ECMO (14%) and cardiac arrest (6%), p <0.01. Conclusions: Cardiac perforation during cardiac catheterization is a life-threatening complication with a range of associated secondary complications. Higher CRISP score, lower age and radio-frequency perforation of pulmonary valve are independent predictors.