Objective: Choosing the right vessel in pediatric catheterization is an important factor affecting the success of the procedure. In this study, we aimed to compare two different approaches used for catheterization in terms of procedural success and complications.

Material and Method: Neonatal and infant patients who underwent left heart catheterization under elective conditions in our department between January 2017 and July 2022 were included in the study. These patients underwent balloon aortic valvuloplasty, balloon coarctation angioplasty, ductal stenting, diagnostic imaging in aortic arch pathologies and modified Blalock-Taussig shunt procedures. The patients were divided into two groups: femoral puncture (FP, group 1) and carotid cut-down (CC, group 2).

Results: A total of 107 catheterizations were performed in 99 patients including 53 (49.53%) femoral and 54 (50.47%) carotid catheterizations. Of these, 25 (23.36%) were diagnostic and 82 (76.64%) were interventional catheterization procedures. Patients in the carotid cut-down group had lower body weight, procedure time, vascular access time, and anesthesia time (respectively 3.54 and 3.10 kg, p =0.024; 112.25 and 85.87 min, p <0.001; 20 and 14.01 min, p <0.001; 159 and 145.64 min, p =0.025). The complication rate in patients who underwent femoral puncture was 13.21%. Of these, 4 (7.54%) had circulatory disorders in the lower extremities, 2 (3.77%) stent migration to the pulmonary artery, and 1 (1.88%) stent stenosis. Wound infection was detected in 3 patients (5.55%) in the carotid-cut-down group.

Conclusion: The carotid-cut-down approach can be preferred as the primary vascular access route for left heart catheterization in patients with low body weight or requiring urgent intervention.