Balloon Pulmonary Angioplasty for Inoperable Patients With Chronic Thromboembolic Pulmonary Hypertension. Preliminary Experience in Spain in a Series of 7 Patients

Martín, Maite Velázquez; Gonzalez‐Trevilla, Agustín Albarrán; Charterina, Sergio Alonso; Tejada, Julio García; Romero, José María; Escribano, Pilar

doi:10.1016/j.rec.2015.02.004

Cited by 8 publications

(5 citation statements)

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“…After 51 months' follow-up, 85% of patients were still alive. Three further publications from European centres, one in 37 patients [9] and two others, each in nine patients [24,25], described improvements in mPAP, exercise capacity and functional class after BPA, with low rates of complications.…”

Section: History Evolution and Evidence For Bpamentioning

confidence: 98%

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Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

et al. 2017

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Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA) is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH.

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Section: History Evolution and Evidence For Bpamentioning

confidence: 98%

“…Published studies of BPA are discussed below and summarised in table 1 [9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]43]. The first full report was published in 2001 by FEINSTEIN et al [15] in the USA, describing 18 patients with inaccessible or "nonsurgical" CTEPH.…”

Section: History Evolution and Evidence For Bpamentioning

confidence: 99%

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

et al. 2017

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“…Kataoka et al 8 were among the first who reported improvement in functional class, NT-proBNP levels, and hemodynamics in patients who underwent BPA for CTEPH. Shortly afterward, European centers published their experience with low rates of complications and with improvements in mean PA pressure, exercise capacity, and functional class with BPA 7, 21. Several studies from Japan have reported similar results with improvement in hemodynamics and symptoms and lower rate of complications on follow-up 11, 15, 16, 22, 23, 24.…”

Section: Discussionmentioning

confidence: 97%

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Initial Single-Center Experience

Anand

Frantz

DuBrock

et al. 2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective To evaluate the safety and efficacy of balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) seen at a US medical center. Patients and Methods Patients with inoperable or residual postendarterectomy CTEPH who underwent BPA at Mayo Clinic in Rochester, Minnesota, between August 11, 2014, and May 17, 2018, were included. Invasive hemodynamic, clinical, laboratory, and echocardiographic data were collected and analyzed retrospectively. Results We identified 31 patients (26 with inoperable CTEPH and 5 with residual postendarterectomy CTEPH) who underwent 75 BPA procedures performed in a staged manner to reduce complications. The median number of sessions was 2 (interquartile range [IQR], 1-3) per patient, and the number of vessels treated per session was 3 (IQR, 2-3). Of the 31 patients, 24 (77.4%) were taking pulmonary vasodilators and 22 (71.0%) were taking riociguat. The mean pulmonary arterial pressure decreased from 40 mm Hg (IQR, 29-48 mm Hg) to 29 mm Hg (IQR, 25-37 mm Hg; P <.001); pulmonary vascular resistance decreased from 5.5 Wood units (WU) (IQR, 3.0-7.6 WU) to 3.3 WU (2.2-5.2 WU; P <.001). The follow-up 6-minute walk test was performed in 13 patients and improved from 402 m (IQR, 311-439 m) to 439 m (366-510 m; P =.001). Of the 31 patients, 19 (61.3%) had improvement in New York Heart Association functional class. The mean ± SD nadir of minute ventilation/carbon dioxide production decreased by 3.4±5.5 ( P =.03), reflecting improved ventilatory efficiency. Complications included hemoptysis requiring overnight intensive care unit observation (n=1) and cardiac tamponade requiring pericardiocentesis (n=1). One patient had reperfusion injury requiring intubation, recovered, and was dismissed to home but died unexpectedly within less than 30 days of the procedure. Serious complications occurred in 3 of the 75 BPA procedures (4.0%). Conclusion Our experience with BPA revealed that this procedure has acceptable risk and improves hemodynamics, functional class, and exercise tolerance in patients with inoperable or residual CTEPH.

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“…Thus, the final cohort included 14 studies with a total population of 725 patients ( Supplementary Table 1C). 12,23,28,35,42,[44][45][46][47][48][49][50][51]52 Hemodynamic Parameters Median of the mean mPAP was 43 mmHg (interquartile range (IQR) 40.5-49.25 mmHg) before BPA and 32.5 mmHg (IQR 25-33.5 mmHg) after BPA (Figure 2A). Median of the mean CI of included studies was 2.35 L/min/m 2 (IQR 2.23-2.70 L/min/m 2 ) before BPA and 2.62 L/min/m 2 (IQR 2.5-2.92 L/min/m 2 ) after BPA ( Figure 2B).…”

Section: Analysis Of Outcomesmentioning

confidence: 99%

Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension　― A Systematic Review and Meta-Analysis ―

Zoppellaro

Badawy

Squizzato

et al. 2019

Circ J

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Background: Balloon pulmonary angioplasty (BPA) is a percutaneous treatment option for patients affected by chronic thromboembolic pulmonary hypertension (CTEPH) and either judged inoperable or with persistent symptoms after pulmonary endoarteriectomy. Current data regarding BPA are sparse and results vary according to local center experience. A systematic review of the literature was performed to better understand the effectiveness and safety of BPA in the treatment of CTEPH. Methods and Results: PubMed and EMBASE were searched for studies reporting BPA results in patients with CTEPH. Differences in clinical and hemodynamic parameters before and after the procedure were analyzed. Weighted mean proportion and 95% confidence intervals (CIs) of adverse events were calculated. In total, 14 studies were included (725 patients). BPA was associated with a reduction in mean pulmonary artery pressure (from 43 to 32.5 mmHg), reduction in pulmonary vascular resistance (from 9.94 to 5.06 Woods units), increase in cardiac index (from 2.35 to 2.62 L/min/m 2), and improvement of 6-minute walking distance (from 345 to 442 m). Periprocedural mortality occurred in 2.1% of patients (95% CoI 0.8-4.1) while reperfusion and pulmonary vessel injuries occurred in 9.3% (95% CoI 3.1-18.4) and 2.3% (95% CoI 0.9-4.5) of total BPA sessions, respectively. Conclusions: Our systematic review suggested that BPA for CTEPH patients was an effective and relatively safe treatment option.

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Balloon Pulmonary Angioplasty for Inoperable Patients With Chronic Thromboembolic Pulmonary Hypertension. Preliminary Experience in Spain in a Series of 7 Patients

Cited by 8 publications

References 5 publications

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Initial Single-Center Experience

Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension　― A Systematic Review and Meta-Analysis ―

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Balloon Pulmonary Angioplasty for Inoperable Patients With Chronic Thromboembolic Pulmonary Hypertension. Preliminary Experience in Spain in a Series of 7 Patients

Cited by 8 publications

References 5 publications

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Initial Single-Center Experience

Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension ― A Systematic Review and Meta-Analysis ―

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Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension　― A Systematic Review and Meta-Analysis ―