Phenotypic profile and predictors of adverse outcomes during paediatric cardiac catheterisation at an academic hospital, South Africa.

Background: Paediatric cardiac catheterization is pivotal in the diagnosis and management of patients with congenital heart disease. Although cardiac referral centres exist, access to cardiac surgery remains limited in low-income countries. The study aimed to describe the demographic and clinical profile, determine adverse outcomes, and identify predictors of complications among children undergoing cardiac catheterization at a state hospital in Johannesburg, Gauteng. Methods: A retrospective cohort study was performed on children aged 0-18 years with congenital heart disease who presented for cardiac catheterisation between January 2018 and December 2022. Patient data was obtained from the cardiac catheterisation laboratory, anaesthetic records and the paediatric cardiac database. Descriptive and multivariate regression data analysis were performed. Results: A total of 597 paediatric cardiac catheterization procedures were analysed. The median (IQR) age was 1.8 (0.8-4.0) years with 52% males. Two-thirds, 397 (66%), were on anti-failure treatment and 236 (40%) had pulmonary hypertension. The Catheterisation RISk score for Paediatrics (CRISP) score was significantly associated with complications AOR 1.21 (95% CI 1.10-1.33; Conclusion: The current study demonstrates that paediatric cardiac catheterisation procedures in a high-burden, resource-limited South African setting are associated with a diverse patient population, including a significant proportion with pulmonary hypertension and those receiving anti-failure therapy. Despite these challenges, the overall incidence of severe adverse outcomes including mortality remained low, supporting the feasibility and safety of these interventions when managed by an experienced multidisciplinary team.