title: Balloon angioplasty and stenting of branch pulmonary arteries: adverse events and procedural characteristics: results of a multi-institutional registry.
abstract: BACKGROUND
  Pulmonary artery (PA) balloon angioplasty and/or stenting (PA rehabilitation) is one of the most common procedures performed in the cardiac catheterization laboratory, but comprehensive and consistently reported data on procedure-related adverse events (AE) are scarce.
  
  
  RESULTS
  Data were prospectively collected using a multicenter registry (Congenital Cardiac Catheterization Project on Outcomes). All cases that included balloon angioplasty and/or stent implantation in a proximal or lobar PA position were included. Multivariate analysis was used to evaluate for independent predictors of AE and need for early reintervention. Between February 2007 and December 2009, 8 institutions submitted details on 1315 procedures with a PA intervention. An AE was documented in 22% with a high severity (level 3 to 5) AE in 10% of cases. Types of AE included vascular/cardiac trauma (19%), technical AE (15%), arrhythmias (15%), hemodynamic AE (14%), bleeding via endotracheal tube/reperfusion injury (12%), and other AE (24%). AE were classified as not preventable in 50%, possibly preventable in 41%, and preventable in 9%. By multivariate analysis, independent risk factors for level 3 to 5 AE were presence of ≥2 indicators of hemodynamic vulnerability, age below 1 month, use of cutting balloons, and operator experience of <10 years. Reintervention during the study period occurred in 22% of patients undergoing PA rehabilitation.
  
  
  CONCLUSIONS
  PA rehabilitation is associated with a 10% incidence of high-level severity AE. Hemodynamic vulnerability, young age, use of cutting balloons, and lower operator experience were significant independent risk factors for procedure-related AE.
authors.affiliation: The Heart Center, Nationwide Children's Hospital, Columbus OH 43205, USA. Ralf.Holzer@NationwideChildrens.org
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Holzer
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kreutzer
authors.forename: Ryan
authors.initials: R
authors.lastname: Leahy
authors.forename: Joshua
authors.initials: J
authors.lastname: Murphy
authors.forename: James E
authors.initials: JE
authors.lastname: Lock
authors.forename: John P
authors.initials: JP
authors.lastname: Cheatham
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000379:methods; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery; D012042:Registries; D015607:Stents / Q000009:adverse effects*