Pulmonary endarterectomy (PEA) may not achieve full clearance of vascular obstructions in patients with more distal chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) may be indicated to treat these residual vascular lesions. We compared whether patients post‐PEA (PP) treated by BPA derived similar benefit to those who had inoperable CTEPH (IC), and assessed predictors of BPA response after surgery. We treated 109 patients with BPA—89 with IC and 20 PP. Serial right heart catheterization performed at baseline (immediately before BPA) and 3 months after completing BPA, compared pulmonary vascular resistance (PVR), mean pulmonary artery pressure (mPAP) as well as change in WHO functional class and 6‐minute walk distance. We also assessed the impact of total thrombus tail length (TTTL) from photographed PEA surgical specimens and PP computed tomography pulmonary angiography (CTPA)‐quantified residual disease burden on BPA response. PP and IC groups did not differ significantly in terms of demographics, baseline hemodynamics or procedural characteristics. However, IC derived greater hemodynamic benefit from BPA: ΔPVR (−27.9 ± 20.2% vs. −13.9 ± 23.9%, p < 0.05) and ΔmPAP (−17.1 ± 14.4% vs. −8.5 ± 18.0%, p < 0.05). There was a negative correlation between pre‐BPA PVR and TTTL (r = −0.47, p < 0.05) which persisted post‐BPA. PVR, mPAP, WHO FC and 6MWD were not improved significantly post‐BPA in PP patients. BPA response was not related to TTTL terciles or CTPA‐quantified residual disease burden. Patients PP experienced inferior response to BPA, despite similar baseline and procedural characteristics to IC. BPA does not abolish the relationship between TTTL and postsurgical PVR in PP patients, suggesting that BPA is less effective in treating residual PH after surgery in an experienced surgical center.

Acute lung injury (ALI) is a common but poorly defined and understood complication of balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH). Little data are available on the medium term clinical outcomes of BPA complicated by ALI. We analyzed per-procedure data from 282 procedures in 109 patients and per-patient data from 85 patients. Serial right heart catheterization at baseline, after each BPA and at 3-month follow-up measured pulmonary vascular resistance (PVR), mean pulmonary artery pressure (mPAP), and cardiac output (CO). ALI (ALI+) was identified by chest radiography alone (ALI r +) or in association with hypoxia clinically (ALI cr +). Procedural predictors of ALI and patient outcomes at 3-months were compared no ALI (ALI−). ALI+ occurred in 17/ 282 (6.0%) procedures (ALI cr +: 2.5%, ALI r +: 3.5%). Prevailing haemodynamics (PVR: p < 0.01; mPAP: p < 0.05) at a procedural and patient level, as well as number of BPA sessions (p < 0.01), total number of vessels (p < 0.05), and occlusions (p < 0.05) treated at a patient level predicted ALI+. Those with ALI had greater percentage improvement in ΔCAMPHOR symptoms score (ALI+: −63.5 ± 35.7% (p < 0.05); ALI cr +: −84.4 ± 14.5% (p < 0.01); ALI−: −27.2 ± 74.2%) and ΔNT-proBNP (ALI cr +: −78.4 ± 11.9% (p < 0.01); ALI−: −42.9 ± 36.0%) at follow-up. There was no net significant difference in haemodynamic changes in ALI+ versus ALI− at follow-up. ALI is predicted by haemodynamic severity, number of vessels treated, number of BPA sessions, and treating occlusive disease. ALI in this cohort was associated with a clinical advantage at follow-up.

against each standard was measured, with subgroup analysis by gestation. Results When transferring preterm babies to the neonatal unit who required respiratory support, CPAP was appropriate and used in all cases (100% compliance). LISA (less invasive surfactant administration) was introduced part way through the data collection period in 2019 and used in 2 out of 8 eligible babies (25% compliance) (see quality statement 2, figure 1). Invasive ventilation was always synchronised (100%), however volume-targeted ventilation in combination with synchronised ventilation was used in only 2 out of 12 eligible babies (16.7% compliance). Target oxygen saturation ranges were not routinely documented in the notes and therefore compliance was not calculatable. Parent involvement in day-to-day care was documented in 87% of the medical notes. The incidence of pneumothorax was 2.4% involving 2 babies born between 32 and 36+6 weeks, both requiring treatment for this. The incidence of bronchopulmonary dysplasia was diagnosed in 4 babies, who were all born before 32 weeks gestation and still required a form of respiratory support at 36 weeks gestation.