The authors used the PHIS database to review catastrophic adverse outcomes of either death and/or the initiation of mechanical circulatory support within one day of cardiac catheterization in 4,401 patients (6,339 procedures) with a diagnosis of Pulmonary Hypertension from 38 centers.

Patients were aged 0–21 years, and the timeframe of the catheterizations was January 2007–December 2012. The percentage of patients in etiologic groups were:

• Idiopathic PAH (21%)
• Associated PAH with CHD (69%)
• PAH with cardiomyopathy (6%)
• PAH s/p Transplant (4%)
• CTEPH (1%).

The review excluded patients who were already on ECMO at the time of cath.

Mechanical support was used within one day in 206 patients (3.3%), and 17 (0.3%) patients died. The risk of death before discharge was 6.6% (n = 416), with an increased risk of death if placed on mechanical support within one day of cath (15.1%).

Multivariate modeling showed an adjusted risk of 3.3% of the composite risk.

Independent predictors of adverse outcomes were: 

• Younger age
• Cardiac operation in the same admission
• Pre-procedural systemic vasodilator infusion
• Hemodialysis.

Pre-procedure use of pulmonary vasodilators was associated with reduced risk of composite outcomes.

A secondary analysis identified an association between center volume and the risk of early catastrophic adverse effects.

The transcatheter intervention was associated with a lower risk of the negative outcome; this may have been a selection bias for choosing not to intervene in sicker patients or indicated a reversible anatomic issue from successful treatment.

All editors: B. Rush Waller, III, MD