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Variation in Advanced Diagnostic Imaging Practice Patterns and Associated Risks Prior to Superior Cavopulmonary Connection: A Multicenter Analysis

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Abstract

Single ventricle patients typically undergo some form of advanced diagnostic imaging prior to superior cavopulmonary connection (SCPC). We sought to evaluate variability of diagnostic practice and associated comprehensive risk. A retrospective evaluation across 4 institutions was performed (1/1/2010–9/30/2016) comparing the primary modalities of cardiac catheterization (CC), cardiac magnetic resonance (CMR), and cardiac computed tomography (CT). Associated risks included anesthesia/sedation, vascular access, total room time, contrast agent usage, radiation exposure, and adverse events (AEs). Of 617 patients undergoing SCPC, 409 (66%) underwent at least one advanced diagnostic imaging study in the 60 days prior to surgery. Seventy-eight of these patients (13%) were analyzed separately because of a concomitant cardiac intervention during CC. Of 331 (54%) with advanced imaging and without catheterization intervention, diagnostic CC was most common (59%), followed by CT (27%) and CMR (14%). Primary modality varied significantly by institution (p < 0.001). Median time between imaging and SCPC was 13 days (IQR 3–33). Anesthesia/sedation varied significantly (p < 0.001). Pre-procedural vascular access did not vary significantly across modalities (p = 0.111); procedural access varied between CMR/CT and CC, in which central access was used in all procedures. Effective radiation dose was significantly higher for CC than CT (p < 0.001). AE rate varied significantly, with 12% CC, 6% CMR, and 1% CT (p = 0.004). There is significant practice variability in the use of advanced diagnostic imaging prior to SCPC, with important differences in associated procedural risk. Future studies to identify differences in diagnostic accuracy and long-term outcomes are warranted to optimize diagnostic protocols.

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Funding

This study has received partial support by a Grant from Children’s Hospital and Clinics of Minnesota’s Education and Research, unrestricted research grants from Siemens Healthineers and the Jon DeHaan Foundation.

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Authors and Affiliations

  1. Cardiac Center, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA

    Ari J. Gartenberg & Andrew C. Glatz

  2. Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA

    Mariana Nunes, Susan A. Casey, Dawn R. Witt, Christian W. Schmidt, John Lesser & B. Kelly Han

  3. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Lindsay Griffin & Cynthia K. Rigsby

  4. The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA

    Aimee K. Armstrong

  5. Children’s Minnesota Mayo Cardiology Collaborative, Minneapolis, MN, USA

    B. Kelly Han

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  1. Ari J. Gartenberg
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  4. Lindsay Griffin
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  9. Christian W. Schmidt
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  10. John Lesser
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Correspondence to Ari J. Gartenberg.

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Each site received local Institutional Review Board (IRB) approval prior to patient enrollment, with waiver of the need for informed consent due to the retrospective nature of the study.

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Gartenberg, A.J., Glatz, A.C., Nunes, M. et al. Variation in Advanced Diagnostic Imaging Practice Patterns and Associated Risks Prior to Superior Cavopulmonary Connection: A Multicenter Analysis. Pediatr Cardiol 43, 497–507 (2022). https://doi.org/10.1007/s00246-021-02746-3

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