Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers
Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers
复制标题
DOI：
10.1016/j.jacc.2006.07.061
复制
发表时间：
2006-12-19
影响因子：
24
通讯作者：
Rubin, Lewis J.
中科院分区：
文献类型：
--
作者：
Hoeper, Marius M.;Lee, Stephen H.;Rubin, Lewis J.
目的：本研究旨在评估肺动脉高压患者右心导管置入的相关风险。背景：右心导管、肺血管反应性检测和肺血管造影是肺动脉高压患者公认的诊断工具，但与这些手术相关的风险尚未在多中心研究中得到系统评估。方法：我们对肺动脉高压患者进行了一项5年多中心回顾性研究和6个月的前瞻性评估，肺动脉高压患者在静息时平均肺动脉压bbb25 mm Hg，接受右心导管插入术，伴或不伴肺血管反应性试验或肺血管造影。结果：在回顾性研究期间，报告了5727例右心导管手术，而在前瞻性研究期间，报告了1491例右心导管手术，总共进行了7218例右心导管手术。回顾性分析和前瞻性分析的结果几乎相同。严重不良事件总数为76例（1.1%，95%可信区间为0.8% ~ 1.3%）。最常见的并发症与静脉通路有关（如血肿、气胸），其次是与迷走神经反应或肺血管反应性试验有关的心律失常和低血压发作。这些并发症绝大多数是轻度到中度的，自发或经过适当的干预后解决。4例死亡事件与任何导管操作相关，导致总体手术相关死亡率为0.055%（95%可信区间为0.01%至0.099%）。结论：在经验丰富的中心，肺动脉高压患者的右心导管手术与低发病率和死亡率相关。
OBJECTIVES This study sought to assess the risks associated with right heart catheter procedures in patients with pulmonary hypertension.BACKGROUND Right heart catheterization, pulmonary vasoreactivity testing, and pulmonary angiography are established diagnostic tools in patients with pulmonary hypertension, but the risks associated with these procedures have not been systematically evaluated in a multicenter study.METHODS We performed a multicenter 5-year retrospective and 6-month prospective evaluation of serious adverse events related to right heart catheter procedures in patients with pulmonary hypertension, as defined by a mean pulmonary artery pressure > 25 mm Hg at rest, undergoing right heart catheterization with or without pulmonary vasoreactivity testing or pulmonary angiography.RESULTS During the retrospective period, 5,727 right heart catheter procedures were reported, and 1,491 were reported from the prospective period, for a total of 7,218 right heart catheter procedures performed. The results from the retrospective and the prospective analyses were almost identical. The overall number of serious adverse events was 76 (1.1%, 95% confidence interval 0.8% to 1.3%). The most frequent complications were related to venous access (e.g., hematoma, pneumothorax), followed by arrhythmias and hypotensive episodes related to vagal reactions or pulmonary vasoreactivity testing. The vast majority of these complications were mild to moderate in intensity and resolved either spontaneously or after appropriate intervention. Four fatal events were recorded in association with any of the catheter procedures, resulting in an overall procedure-related mortality of 0.055% (95% confidence interval 0.01% to 0.099%).CONCLUSIONS When performed in experienced centers, right heart catheter procedures in patients with pulmonary hypertension are associated with low morbidity and mortality rates.