DOI: 10.1161/jaha.125.048088 ISSN: 2047-9980

Association Between Trainee Involvement During Pediatric and Congenital Cardiac Catheterization and Procedural Outcomes

Natalie Jayaram, John A. Spertus, Kevin F. Kennedy, Andrew C. Glatz
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Background

Participation in the cardiac catheterization laboratory is a requirement of cardiology fellowship training. We sought to determine whether trainee presence is associated with outcomes during pediatric and congenital cardiac catheterization.

Methods

We identified catheterizations between January 2011 and September 2020 within the IMPACT (Improving Pediatric and Adult Congenital Treatment) Registry. Multivariable multilevel regression was used to determine the association between trainee presence and procedural outcomes.

Results

Of 122 760 catheterizations at 107 academic hospitals, a trainee was present in 71 651 (58.4%) cases. Rates of major adverse events were similar between trainee and nontrainee cases (9.0% versus 8.0%). Contrast dose was also similar for trainee compared with non‐trainee cases (2.81±2.98 versus 2.89±2.74 cc/kg) as was radiation exposure (9.4±30.0 versus 9.7±36.49 milligray/kilogram). Procedural length was slightly higher in trainee cases (1.51±0.91 versus 1.41±0.86 hours). After multivariable adjustment, the rates of a major adverse events between trainee and nontrainee cases remained similar (odds ratio, 1.06 [95% CI, 0.99–1.14], P =0.09). Trainee presence was associated with a 0.66 milligray/kilogram greater radiation dose (95% CI, 0.44–0.88, P <0.001), a 0.034 cc/kilogram higher contrast dose (95% CI, 0.005–0.06, P =0.02), and 6.87 minutes longer procedural time (95% CI, 6.06–7.68, P <0.001).

Conclusions

Trainee presence during pediatric and congenital catheterization is associated with similar rates of major adverse events compared with nontrainee cases but slightly higher contrast use, radiation exposure, and procedural length. These findings overall support the safety of involving trainees in these procedures.

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