Title: KEEPING THE RIGHT HEART IN MIND: SAFETY PROFILE OF RIGHT HEART CATHETERIZATION
Abstract: PURPOSE: Given the decrease in indications for pulmonary artery catheterization (PAC) in recent decades, there are concerns about the experience and safety of performing right heart catheterizations (RHC).Presently, there is a paucity of real-world data on RHC safety.Therefore, we sought to identify the safety of RHC in the evaluation of patients with indications such as pulmonary hypertension, unexplained dyspnea, and heart failure. METHODS:We conducted a retrospective study of RHCs performed by cardiology and pulmonary services in the cardiac catheterization lab of a large tertiary academic medical center.Patients were included if they underwent an isolated diagnostic RHC between January 2018 and February 2023.Patient demographics, sedation administration, hemodynamic data, and procedural complications were obtained.RHC-related complications to be captured included: venous access site complications, arrhythmias, sedation-related adverse effects, respiratory failure, hospitalization, and death.RESULTS: A total of 317 cases fulfilled the inclusion criteria.Most patients were female (53.7%), with a mean age of 63.8 years.The main indication for RHC was pulmonary hypertension (32%) and dyspnea workup (26%).Of the 317 RHCs, 171 were performed by cardiology (17 cardiologists) and 146 by pulmonary (1 pulmonologist).The most common venous access of choice was the common femoral vein (53.6%), followed by the internal jugular vein (37.8%).Ultrasound guidance was employed in 90% of the cases.A micropuncture venous access technique was used in 78.8% of the cases.A wire was needed to advance the PAC into the pulmonary circulation in 41% of the cases.The femoral vein was the access route for about 3 / 4 of the cases requiring a wire.A combination of local analgesia and systemic sedation was used in 73.5% of the cases, while local analgesia was used exclusively in 26.5%.The most common drug regimen used for systemic sedation was a combination of fentanyl and midazolam (46.6%).In the pulmonary RHC group, there was a distinct trend towards the sole use of local anesthesia in the last two years (63.8%, compared to 8% in the first three years).Procedure-related complications occurred in only 2 of the 317 cases.The complications were thrombosis at the venous access site (non-ultrasound-guided access) and transient ventricular arrhythmia while advancing the PAC. CONCLUSIONS:We identified two procedure-related complications in this large group of RHCs (0.6%).There were no vascular complications in the ultrasound-guided intravenous access.The procedure had an excellent safety profile, even when performed by a diverse group of providers.Local analgesia use has increased as the sole method of pain control.CLINICAL IMPLICATIONS: There are still many clinically relevant indications for RHC, and the procedure has an excellent safety profile.Safety concerns should not deter providers from considering this procedure for their patients when clinically indicated.Interventions such as using primarily local analgesia could lead to an even lower risk of complications and may expedite these patients' recovery time and discharge.