Journal of Pediatric Cardiology and Cardiac Surgery

Background: A carotid artery approach is advantageous for cardiac catheterization in infants and children. Conventionally, the surgical cutdown access method is popular; however, recent advancements in medical device technology have led to the development of the percutaneous carotid access method. This study aimed to evaluate the advantages and safety of percutaneous carotid access using 3-French sheath compared with those of surgical cutdown access.

Methods: We retrospectively reviewed data of 17 children who underwent cardiac catheterization via the carotid access approach between January 2003 and April 2021. Patients were divided into two groups: those who underwent surgical cutdown (Cutdown group, 2003–2013; n=10) and those who underwent percutaneous carotid access (Puncture group, 2014–2021; n=7).

Results: The median ages at the time of procedure were 2 months and 1 month in the Cutdown and Puncture groups, respectively (p=0.13). In the Cutdown group, three, four, and three patients required sheath sizes 3-French, 4-French, and 5-French or larger, respectively; on the other hand, a 3-French sheath was used in all patients in the Puncture group. The median time to vascular access and that from sheath removal to exit the room were 33 min and 36 min in the Cutdown group, and 3 min and 25 min in the Puncture group, respectively (p=0.01). No patients exhibited complications related to vascular access.

Conclusions: The percutaneous carotid access approach with a 3-French sheath in infants has the potential to reduce procedure time and to provide a comparable or safer, less invasive catheterization than with the conventional method.