Abstract
Background Interventional cardiac catheterizations have gained major importance in the treatment
of congenital heart defects (CHDs). Since patients with CHDs frequently require lifelong
medical care and sometimes subsequent invasive treatment, repeated radiation exposure
during interventional procedures is a relevant issue concerning potential radiation-related
risks. Therefore, a 9-year subanalysis on radiation data during interventional cardiac
catheterizations from the German Registry for Cardiac Operations and Interventions
in patients with CHDs was performed.
Methods The German Registry for Cardiac Operations and Interventions in Patients with CHDs
is a real-world, prospective all-comers database collecting clinical and procedural
data on invasive treatment of CHDs. From January 2012 until December 2020, a total
of 28,374 cardiac catheter interventions were recorded. For a homogeneous case mix
and for obtaining comparable data, eight specified interventions were selected for
detailed evaluation. The selected procedures were: atrial septal defect (ASD)/patent
foramen ovale (PFO) occlusion, patent ductus arteriosus (PDA) occlusion, ventricular
septal defect (VSD) occlusion, coarctation of the aorta (CoA) balloon dilatation and
stent implantation, aortic valvuloplasty, pulmonary valvuloplasty, and transcatheter
pulmonary valve implantation (TPVI). Data on radiation exposure included total fluoroscopy
time (TFT), dose area product (DAP), and DAP per body weight (DAP/BW).
Results The cohort accounted for 9,350 procedures, including 3,426 ASD/PFO occlusions, 2,039
PDA occlusions, 599 aortic and 1,536 pulmonary valvuloplasties, 383 balloon dilatations
and 496 stent implantations for CoA, 168 VSD occlusions, and 703 TPVI. Six hundred
and ten ASD/PFO procedures (17.8%) were performed without radiation. During the 9-year
period, median annual TFT, DAP, and DAP/BW showed a continuous decrease while radiation
burden correlated with intervention complexity: For ASD/PFO and PDA occlusion, aortic
and pulmonary valvuloplasty as well as balloon dilatation of CoA the median DAP/BW
was <20.0 μGy*m2/kg, while median values of 26.3 μGy*m2/kg and 31.6 μGy*m2/kg were noted for stent treatment of CoA and VSD closure, respectively. Radiation
burden was highest in TPVI with a median TFT of 23.6 minutes, median DAP of 4,491 μGy*m2, and median DAP/BW of 79.4 μGy*m2/kg.
Conclusion A decrease in radiation exposure was found in eight cardiac interventions from January
2012 to December 2020. Comparison with international registries revealed a good quality
of radiation protection. The data underline the requirement of surveillance of radiation
burden, especially in this patient group.
Keywords
congenital heart disease - CHD - pediatric - cardiac catheterization/intervention
(including PCI) - stents - database
