Matthew J Lewis1, Kevin F Kennedy2, Jonathan Ginns3, Matthew A Crystal4, Alejandro Torres4, Julie Vincent4, Marlon S Rosenbaum3. 1. 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. 2. Mid-America Heart Institute, Kansas City, Missouri. 3. Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York. 4. Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, New York.
Abstract
BACKGROUND: Risk factors associated with outcomes for pulmonary artery (PA) stenting remain poorly defined. OBJECTIVES: 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.
RCT Entities:
BACKGROUND: Risk factors associated with outcomes for pulmonary artery (PA) stenting remain poorly defined. OBJECTIVES: 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 biventricularpatients 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. Biventricularpatients 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: John P Welby; Erin A Fender; Tobias Peikert; David R Holmes; Haraldur Bjarnason; Erica M Knavel-Koepsel Journal: Cardiovasc Intervent Radiol Date: 2020-11-17 Impact factor: 2.740
Authors: Moon Sun Kim; Ja Kyoung Yoon; Seong Ho Kim; Ji Seok Bang; So Ick Jang; Sang Yoon Lee; Eun Young Choi; Su Jin Park; Hye Won Kwon Journal: Korean J Pediatr Date: 2018-06-25