Registry Looks at Balloon Angioplasty and Stenting of Branch Pulmonary Arteries

April 26, 2011—Ralf J. Holzer, MD, et al published results of a multi-institutional registry studying adverse events and procedural characteristics of balloon angioplasty and stenting of branch pulmonary arteries (PAs). The study is available online ahead of print in Circulation: Cardiovascular Interventions.

The investigators noted that although PA balloon angioplasty and/or stenting (PA rehabilitation) is one of the most common procedures performed in the cardiac catheterization laboratory, comprehensive and consistently reported data on procedure-related adverse events are scarce.

As detailed by the investigators, data were prospectively collected using a multicenter C3PO (Congenital Cardiac Catheterization Project on Outcomes) registry. 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 adverse events and need for early reintervention. Between February 2007 and December 2009, eight institutions submitted details on 1,315 procedures with a PA intervention.

An adverse event was documented in 22% of patients with a high severity (level 3–5) event in 10% of cases. The types of adverse events included vascular/cardiac trauma (19%), technical (15%), arrhythmias (15%), hemodynamic (14%), bleeding via endotracheal tube/reperfusion injury (12%), and others (24%). Adverse events 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 events were the presence of two or more indicators of hemodynamic vulnerability, age < 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.

The investigators concluded that PA rehabilitation is associated with a 10% incidence of high-level severity adverse events and that hemodynamic vulnerability, young age, use of cutting balloons, and lower operator experience were significant independent risk factors for procedure-related adverse events.