Pediatr Cardiol. 2025 Oct 17. doi: 10.1007/s00246-025-04061-7. Online ahead of print.
ABSTRACT
Despite interventions to enlarge/create an atrial communication having been performed for several decades, only a single larger multi-center study has reported procedural adverse events on at least 200 patients. Most studies have included associated interventions performed in the same setting and have not differentiated by procedural techniques, limiting the ability to derive conclusions from those reports. 432 cases from the C3PO-QI registry dataset from 01/2014 to 12/2017 who underwent interventions to enlarge/create an atrial communication were included (excluding patients with other interventions performed in the same setting). Patient- and procedure-specific data were analyzed, and risk factors for clinically meaningful adverse events (CMAE) were identified. 63% of interventions to enlarge/create an atrial communication were performed < = 30 days of age, 18% age 1-11 months, and 19% > = 1 year. 91% were non-elective procedures. For atrial access, 18% required needle or radiofrequency (RF) puncture. Balloon septostomy alone was performed in 73%, atrial septoplasty (± BAS) in 12%, and atrial stent or blade septostomy in 15%. CMAE occurred in 6.5% of cases (mortality 2%). By multivariable analysis, risk factors for CMAE were single ventricle and atrial needle or RF puncture. When analyzing neonates and patients one year of age or older separately, pre-procedural ECMO, single-ventricle physiology, atrial access via needle or RF puncture, and type of atrial intervention other than standard BAS, were all associated with an increased incidence of CMAE in neonates, but not in patients 1 year of age or older. Interventions to enlarge/create an atrial communication carry a risk of CMAE that varies by age group, with ECMO at the start, single-ventricle physiology, atrial access via needle or RF puncture, and type of atrial intervention anything other than standard BAS being significant risk factors for CMAE in neonates, but not in patients above 1 year of age.
PMID:41107484 | DOI:10.1007/s00246-025-04061-7
