Background

Despite recent technical advances, interventional cardiac catheterization is still challenging in neonatal age and no specific data concerning early outcome are so far published in literature.

Methods

Neonatal trans-catheter cardiac interventions performed in high-volume Italian referral centers were retrospectively analyzed. Primary outcomes were procedural major adverse events, in-hospital mortality and procedural failure. Secondary outcomes were minor adverse events and need for blood transfusion.

Results

From January 2000 to December 2017, 1423 newborns (mean weight 3.0 ± 0.6 kg, range 1.0–5.8; median age 2.0 days) underwent interventional cardiac catheterization. Overall, global procedure adverse event rate and in-hospital mortality were 10.2% and 5.2%, respectively. At multi-variable analysis, primary composite outcome was significantly related to low-weight (<2.5 kg) (p < 0.01) and younger age (≤7 days) (p < 0.01) at the procedure, prematurity (p < 0.01), uni-ventricular physiology (p < 0.01), associated genetic syndromes (p < 0.01) and procedure risk category (p < 0.01). No relationship between volume of activity of any single center and procedure outcome was found. Over time, a trend toward an increased number of procedures and their complexity was recorded. Trans-catheter management of cardiac malformations with critical, duct-dependent pulmonary blood flow by arterial duct stenting or right ventricular outflow tract stenting showed the highest increase.

Conclusions

Interventional cardiac catheterization is relatively safe and feasible in neonatal age. Peri-natal age, low weight, uni-ventricular physiology and genetic syndromes still significantly contribute to procedural morbidity and in-hospital mortality of this approach.

中文翻译：

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新生儿时代的介入性心脏导管插入术：带来了多中心的意大利经验。

背景

尽管最近有技术上的进步，但介入式心脏导管插入术在新生儿时代仍具有挑战性，迄今为止，有关早期结果的具体数据尚未在文献中发表。

方法

回顾性分析了在意大利大量转诊中心进行的新生儿经导管心脏介入治疗。主要结果是程序上的主要不良事件，院内死亡率和程序失败。次要结果是轻微的不良事件，需要输血。

结果

从2000年1月至2017年12月，对1423例新生儿（平均体重3.0±0.6千克，范围1.0–5.8；中位年龄2.0天）进行了心脏导管介入治疗。总体而言，全球手术不良事件发生率和医院内死亡率分别为10.2％和5.2％。在多变量分析中，该过程的主要复合终点与低体重（<2.5 kg）（p <0.01）和年龄较小（≤7天）（p <0.01），早产（p <0.01），单心室生理学（p <0.01），相关遗传综合征（p <0.01）和手术风险类别（p <0.01）。没有发现任何单个中心的活动量与手术结果之间的关系。随着时间的流逝，记录了越来越多的程序及其复杂性的趋势。严重，严重的心脏畸形的经导管管理

结论

在新生儿时期，介入性心脏导管插入术是相对安全且可行的。围产期年龄，低体重，单心室生理和遗传综合症仍然对这种方法的手术发病率和院内死亡率起重要作用。