Congenital heart disease: addressing the need for novel lower-risk percutaneous interventional strategies

ABSTRACT

Introduction

With the advent of improved neonatal care, increasingly vulnerable higher-risk patients with complex congenital heart anomalies are presenting for intervention. This group of patients will always have a higher risk of an adverse event during a procedure but by recognizing this risk and with the introduction of risk scoring systems and thus the development of novel lower risk procedures, the rate of adverse events can be reduced.

Area covered

This article reviews risk scoring systems for congenital catheterization and demonstrates how they can be used to reduce the rate of adverse events. Then, novel low risk strategies are discussed for low-weight infants e.g. patent ductus arteriosus (PDA) stent insertion; premature infants e.g. PDA device closure; and transcatheter pulmonary valve replacement. Finally, how risk is assessed and managed within the inherent bias of an institution is discussed.

Expert opinion

There has been a remarkable improvement in the rate of adverse events in congenital cardiac interventions, but now, as the benchmark of mortality rate is switched to morbidity and quality of life, continued innovation into lower risk strategies and understanding the inherent bias when assessing risk will be key to continuing this improvement.

KEYWORDS:

• Congenital heart disease
• Interventional cardiology
• Low weight infants
• Risk management
• Risk scores

Article highlights

• Evolution of risk scoring systems to improve standardization and outcomes in congenital catheterization.

• Low-weight infants and how treatments have evolved to mitigate the risk of surgical therapies in this high-risk group.

• Transcatheter pulmonary valve replacement as an alternative to surgical replacement, and how early data demonstrates excellent results.

• Decision-making in the catheterization laboratory and how inherent bias can affect our decisions, and how to acknowledge these biases when prepping for cases.

Declaration of interest

Z Hijazi is a consultant for NUMED and Occlutech. D Kenny is a consultant for Occlutech, Edwards, Medtronic and Venus. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.