Radiation exposure during cardiac interventions in CHD: German Registry 2012-2020.

Background: Since patients with congenital heart defects (CHD) frequently require life-long medical care and repeat invasive treatment, radiation exposure during interventional procedures is a relevant issue concerning potential radiation related risks. Therefore, an analysis on radiation data from the German Registry for Cardiac Operations and Interventions in patients with CHD was performed.

Methods: From January 2012 until December 2020 a total of 28,374 cardiac catheter interventions were recorded. 8 specified interventions were selected for evaluation: ASD/PFO, PDA and VSD occlusion, CoA balloon dilatation and stent implantation, aortic valvuloplasty, pulmonary valvuloplasty and transcatheter pulmonary valve implantation. Radiation exposure data included total fluoroscopy time (TFT), dose area product (DAP) and DAP per body weight (DAP/BW).

Results: The cohort accounted for 9,350 procedures including 3,426 ASD/PFO occlusions, 2,039 PDA occlusions, 599 aortic and 1,536 pulmonary valvuloplasties, 383 balloon dilatations resp. 496 stent implantations for CoA, 168 VSD occlusions and 703 TPVI. 610 ASD/PFO procedures (17.8%) were performed without radiation. Median annual TFT, DAP and DAP/BW showed a continuous decrease while radiation burden correlated with intervention complexity: For ASD/PFO and PDA occlusion, aortic and pulmonary valvuloplasty and balloon dilatation of CoA median DAP/BW was <20.0 µGy*m²/kg, while median values of 26.3 µGy*m²/kg and 31.6 µGy*m²/kg were noted for stenting of CoA and VSD closure. Radiation burden was highest in TPVI with a median DAP/BW of 79.4 µGy*m²/kg.

Conclusion: A decrease of radiation exposure was found in 8 cardiac interventions from 1/2012 - 12/2020. Comparison with international registries revealed a good quality of radiation protection.