title: Procedural Success and Adverse Events in Pulmonary Artery Stenting: Insights From the NCDR.
abstract: BACKGROUND
  Risk factors associated with outcomes for pulmonary artery (PA) stenting remain poorly defined.
  
  
  OBJECTIVE
  The goal of this study was to determine the effect of patient and procedural characteristics on rates of adverse events and procedural success.
  
  
  METHODS
  Registry data were collected, and 2 definitions of procedural success were pre-specified for patients with biventricular circulation: 1) 20% reduction in right ventricular pressure or 50% increase in PA diameter; and 2) 25% reduction in right ventricular pressure or 50% decrease in PA gradient or post-procedure ratio of in-stent minimum to pre-stent distal diameter >80%. A separate definition of procedural success based on normalization of PA diameter was pre-specified for patients with single ventricle palliation.
  
  
  RESULTS
  Between January 2011 and January 2014, a total of 1,183 PA stenting procedures were performed at 59 institutions across 1,001 admissions; 262 (22%) procedures were performed in patients with a single ventricle. The rate of procedural success was 76% for definition 1, 86% for definition 2, and 75% for single ventricle patients. In the multivariate analysis, ostial stenosis was significantly associated with procedural success for biventricular patients according to both definitions. The overall complication rate was 14%, with 9% of patients experiencing death or a major adverse event (MAE). According to multivariate analysis, weight <4 kg, having a single ventricle, and emergency status were significantly associated with death or MAEs.
  
  
  CONCLUSIONS
  In our analysis, success was >75% across all definitions, and adverse events were relatively common. Biventricular patients with an ostial stenosis had a higher probability of a successful outcome. Patients who had a single ventricle, weight <4 kg, or who underwent an emergency procedure had a higher risk of death or MAE. These findings may help inform patient selection for PA stenting.
authors.affiliation: Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York. Electronic address: ml3329@cumc.columbia.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Lewis
authors.affiliation: Mid-America Heart Institute, Kansas City, Missouri.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Kennedy
authors.affiliation: Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ginns
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Crystal
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Torres
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Julie
authors.initials: J
authors.lastname: Vincent
authors.affiliation: Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York.
authors.forename: Marlon S
authors.initials: MS
authors.lastname: Rosenbaum
mesh_terms: D000293:Adolescent; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
keywords: cardiac catheterization; congenital heart disease; pulmonary artery stenosis; success rates