Balloon pulmonary angioplasty for patients with chronic thromboembolic pulmonary hypertension previously operated by pulmonary endarterectomy

Andersen, Asger; Hansen, James V.; Dragsbæk, Simone Juel; Mæng, Michael; Andersen, Mads J.; Andersen, G.R.; Mellemjkær, Søren; Ilkjær, Lars Bo; Nielsen‐Kudsk, Jens Erik

doi:10.1002/pul2.12115

Cited by 10 publications

(13 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Primarily, the overall prevalence of peri-procedural complications in our study was 14% and 9% for thoracic complications, none of them were severe. The overall complication rate is comparable to the percentages described in other studies, with a range from 11% to 17% 15,24,25,26 . However, in a recent Japanese study by Ito et al 14 , complications were reported in up to 25% of the BPA treatments.…”

Section: Discussionsupporting

confidence: 86%

“…Here, we analyzed mostly inoperable CTEPH patients, in contrast to the Japanese study in which 46% underwent PEA prior to BPA 14 . Previous PEA, and the distinctive thromboembolic phenotype observed in Japanese patients may contribute to the elevated complication rate described by the Japanese investigators compared to the other studies 5,14,25,27,28 . So far, studies on peri-procedural (thoracic) complications were reported prior to the publication of the ESC BPA consensus paper, describing the definition of BPA related complications in detail.…”

Section: Discussionmentioning

confidence: 77%

See 1 more Smart Citation

Safety of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: role of the standardized definition of complications

van Leusden,

Staal,

van Thor

et al. 2024

Preprint

View full text Add to dashboard Cite

Literature reports high complication rates in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who undergo balloon pulmonary angioplasty (BPA), especially in patients with poor pulmonary hemodynamics. Here we describe complications of BPA based on the new definitions. All patients with CTEPH who completed BPA treatment before September 15th, 2023, were selected from the CTEPH database. Peri-procedural complications were collected and classified according to the 2023 consensus paper on BPA treatment. Complications were analyzed in subgroups of patients with pulmonary vascular resistance (PVR) ≤ or > 6.6 WU and mean pulmonary artery pressure (mPAP) ≤ or > 45 mmHg at first BPA. In this analysis, 87 patients (63% women; mean age 61.1±14.0 years; 62% on dual PH targeted medical therapy) underwent 426 (mean 4.9±1.6 per patient) BPAs. Only non-severe complications occurred in 14% of BPA treatments; in 47% of the patients; 31% patients had a thoracic complication. The thoracic complications were mild (71%) or moderate (29%). Patients with a PVR >6.6 WU (n=8) underwent more BPA treatments (6.6±1.5 versus 4.6±1.5, p=0.002), had more complications (88% versus 41% of patients, p=0.020), and more thoracic complications (17% vs 7% of BPAs, p=0.013) than patients with PVR ≤ 6.6 WU. Patients with mPAP >45 mmHg (n=13) also had more BPA-treatments (6.5±1.7 versus 4.6±1.4, p<0.001), more complications (77% versus 44% of patients, p=0.027) and more thoracic complications (14% versus 8% of BPAs, p=0.039) than patients with mPAP ≤ 45 mmHg. Complications occurred in 14% of BPAs and were mostly mild. Patients with severe pulmonary hemodynamics suffered more (thoracic) complications.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 77%

Safety of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: role of the standardized definition of complications

van Leusden,

Staal,

van Thor

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“… 9 , 11 , 49 However, less hemodynamic improvement than that in primary BPA occurred. 49 Polish authors describe very hard occlusions after PEA, challenging to dilate, 11 potentially resulting in hemoptysis, 50 requiring embolization. 51 …”

Section: Patient Selection and Preparationmentioning

confidence: 99%

Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: a clinical consensus statement of the ESC working group on pulmonary circulation and right ventricular function

Lang,

Andreassen,

Andersen

et al. 2023

European Heart Journal

Self Cite

View full text Add to dashboard Cite

The current treatment algorithm for chronic thromboembolic pulmonary hypertension (CTEPH) as depicted in the 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines on the diagnosis and treatment of pulmonary hypertension (PH) includes a multimodal approach of combinations of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapies to target major vessel pulmonary vascular lesions, and microvasculopathy. Today, BPA of >1700 patients has been reported in the literature from centers in Asia, the US, and also Europe; many more patients have been treated outside literature reports. As BPA becomes part of routine care of patients with CTEPH, benchmarks for safe and effective care delivery become increasingly important. In light of this development, the ESC Working Group on Pulmonary Circulation and Right Ventricular Function has decided to publish a document that helps standardize BPA to meet the need of uniformity in patient selection, procedural planning, technical approach, materials and devices, treatment goals, complications including their management, and patient follow-up, thus complementing the guidelines. Delphi methodology was utilized for statements that were not evidence based. First, an anatomical nomenclature and a description of vascular lesions are provided. Second, treatment goals and definitions of complete BPA are outlined. Third, definitions of complications are presented which may be the basis for a standardized reporting in studies involving BPA. The document is intended to serve as a companion to the official ESC/ERS guidelines.

show abstract

“…Reports on BPA after PEA are sparse and the results are conflicting. Improvements in hemodynamics and functional capacity have been reported in 42 patients included in three studies, 28–30 while a UK report observed more non‐responders with BPA after PEA than with BPA in PEA‐naïve CTEPH patients 31 . Whether these differences can be explained by more aggressive protocols and differences in the number of BPA sessions is uncertain.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary endarterectomy and balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Comparison of changes in hemodynamics and functional capacity

et al. 2023

View full text Add to dashboard Cite

The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Balloon pulmonary angioplasty (BPA) is an emerging option for inoperable patients. Comparisons of the hemodynamic and functional outcome between these treatments are scarce. In this single‐center observational cohort study, we compared hemodynamics by right heart catheterization and peak oxygen consumption before and 5 months (±14 days) after either PEA or BPA. Comprehensive evaluation and selection for PEA or BPA was performed by an expert CTEPH team. Fourty‐two and fourty consecutive patients were treated with PEA or BPA, respectively. Demographics were similar between groups. Both PEA and BPA significantly reduced mean pulmonary artery pressure (from 46 ± 11 mmHg at baseline to 28 ± 13 mmHg at follow‐up; p < 0.001 and from 43 ± 12 mmHg to 31 ± 9 mmHg; p < 0.001) and pulmonary vascular resistance (from 686 ± 347 dyn s cm −5 at baseline to 281 ± 197 dyn s cm −5 at follow‐up; p < 0.001 and from 544 ± 322 dyn s cm −5 to 338 ± 180 dyn s cm −5 ; p < 0.001), with significantly lower reductions for both parameters in the former group. However, cardiopulmonary exercise testing revealed no significant between group differences in exercise capacity. Diffusion capacity for carbon monoxide at baseline was the only follow‐up predictor for peak VO 2 . In our study, PEA reduced pulmonary pressures more than BPA did, but similar improvements were observed for exercise capacity. Thus, while long term data after BPA is lacking, BPA treated CTEPH patients can expect physical gains in line with PEA.

show abstract

Balloon pulmonary angioplasty for patients with chronic thromboembolic pulmonary hypertension previously operated by pulmonary endarterectomy

Cited by 10 publications

References 19 publications

Safety of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: role of the standardized definition of complications

Safety of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: role of the standardized definition of complications

Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: a clinical consensus statement of the ESC working group on pulmonary circulation and right ventricular function

Pulmonary endarterectomy and balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Comparison of changes in hemodynamics and functional capacity

Contact Info

Product

Resources

About