Pediatric therapeutic cardiac catheterization: a statement for healthcare professionals from the Council on Cardiovascular Disease in the Young, American Heart Association.

Introduction During the last few years, dramatic changes have taken place in the pediatric cardiac catheterization laboratory. Improved noninvasive diagnostic techniques have narrowed the indications for diagnostic cardiac catheterization, and the laboratory is now increasingly being used for therapeutic procedures. Concern about the appropriateness of some applications of pediatric therapeutic cardiac catheterization has arisen recently because of numerous catheter techniques, the increased numbers of persons and centers using these techniques, and the increased number of lesion types thought to be amenable to catheter therapy. In comparison with diagnostic cardiac catheterization, therapeutic catheter procedures require more time and resources, are costlier and riskier, and demand more technical training and expertise. High levels of skill are required of the operator who performs the various therapeutic catheterization techniques. These procedures should only be performed in institutions with appropriate facilities, personnel, and programs. These considerations, combined with the rapid increase in the number of laboratories and cardiologists performing therapeutic catheterization procedures, cause concern about hospital and physician credentialing, hospital and physician peer review, and human subjects investigational review. Since publication of the last American Heart Association statement on pediatric therapeutic cardiac catheterization, many new devices and applications have been described, prompting this report on important new techniques in pediatric therapeutic cardiac catheterization. Because much of the information in this statement is still investigational, this statement does not formally represent American College of Cardiology/American Heart Association (ACC/AHA) guidelines. However, the authors believe that the recommendations, which are classified as I, II, and III, represent a consensus. Interventional electrophysiological procedures are not addressed. Personnel Requirements Therapeutic catheterization training programs vary in type, extent, and quality. Because of the complexity and potential risks of these procedures, specific credentialing criteria should be developed for those who wish to begin performing therapeutic catheterization as well as for those who continue to perform various procedures. Performance of therapeutic catheterization in children requires specific training. Pediatric cardiology fellows should receive therapeutic catheterization training in one or more centers that carry out angioplasties, valvuloplasties, and/or vascular occlusion procedures. Before performing a therapeutic catheterization as the primary operator, the fellow or practicing pediatric cardiologist should be required to receive procedurespecific training under the supervision of a qualified individual similar to that required of internist cardiologists who wish to perform coronary angioplasties. Credentialing should be procedure specific. To maintain his or her credentials, the cardiologist should perform or supervise an adequate number of cases annually to maintain skills, and the results must compare favorably with national experience. The cardiologist must be aware of new trends and information through reading and attendance of meetings. However, attending “how-to” seminars and observing experts does not obviate the need for personal experience. An ACC/AHA task force report states that “it is essential that physicians performing angioplasty and related procedures are adequately trained, that facilities and equipment used are capable of obtaining the necessary radiographic information, and that the safety record of the laboratory is acceptable.” The emphasis of this report is on formal credentialing and documentation of training, competence, and ongoing maintenance of skills. The facility, hospital, quality assurance programs, and laboratory personnel associated with the pediatric therapeutic catheterization program must meet applicable national standards of the ACC/AHA Ad Hoc Task Force on Cardiac Catheterization.