Complications of catheterization in congenital heart diseases: A new Risk-Adjusted Score (RIGA-S)

Author(s): Ricardo Gamboa

Catheter interventions have significantly increased over the last 30 years, emerging as a new safe, and effective alternative for the treatment of children and adults with Congenital Heart Disease (CHD). The procedures can present complications, with severe and/or catastrophic ones posing a risk to the patient’s life. The risk-adjusted variables that are conventionally considered are age, the complexity of the procedure, the volume of cases/year of each institution, cases per year of the operator, and existing comorbidities. The American Society of Anesthesiologists (ASA) can also be taken into account in relation to anesthetic risk. The diversity of heart diseases, the incorporation of new techniques, and the use of different devices forced the prediction of adverse events. Different risk-adjusted scores emerged, adjusted by data taken from the results of catheterization, called ‘hemodynamic vulnerability indicators’. These values, along with the procedure time, the radiation received, and the type of anesthesia (with or without endotracheal intubation) have no predictive value and arise from the analysis after the procedure. The case history presented with the new Risk-Adjusted Score (RIGA-S) score is extensive over the years, involving the same operator and covering all stages of the specialty when initially therapeutic catheterizations were only referred to as Rashkind balloon septostomy. In the last stage, the interventions were varied and complex, representing the majority of cases per year in hemodynamics services. This new score is simple, easy to calculate, and predictive, as it analyzes existing data before the procedure, based on the variables: age, type of Congenital Heart Disease (CHD), type of procedure, and previous clinical status: outpatient, admitted to the Intensive Care Unit (ICU) and/or in the immediate postoperative period of cardiovascular surgery. In this way, the case is stratified, the potential risk to the patient and their parents is posed, it allows planning of the procedure with experienced operators, and it warns about the availability of admission to the Intensive Care Unit and/or the need for rescue surgery.