Congenital Cardiac Catheterization Risk Assessment in Infants Under 2.5kg

Background: Premature and small-for-gestational-age neonates with congenital heart disease increasingly require congenital cardiac catheterization (CCC). These patients present unique procedural and patient-specific risks that standard risk models do not fully capture. Objectives: This study aims to assess risk in infants <2.5 kg undergoing CCC, further stratifying by procedural type to better understand predictors of clinically meaningful adverse events (CMAE). Methods: Patient and Procedural data were collected on diagnostic and interventional catheterization procedures for infants <2.5 kg from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry between 2014–2022. Cases were stratified into historical (2014–2018) and modern (2019–2022) eras and further categorized into PDA closure and ‘All Other Cases’. Multivariable logistic regression assessed associations between covariates and the risk of CMAE. Results: Analysis included 1,345 cases. In the modern era, PDA closures (n=898, 66.8%) had a lower CMAE rate at 3.6% versus 8.1% for ‘All Other Cases’ (P<0.001). Among ‘All Other Cases’ (n=447) 23% were diagnostic and 77% interventional, with CMAE rates of 7.7% and 6.4%, respectively. CMAE types varied, with PDA cases mainly experiencing respiratory events (22%) and ‘All Other Cases’ showing higher rates of access complications (27%) and arrhythmias (29%). Conclusion: Risk in infants <2.5 kg undergoing CCC is heavily dependent on procedural type and specific patient factors, highlighting the need for tailored risk assessment tools. This study, the largest to date in this population, emphasizes the importance of individualized care plans to improve outcomes.