Balloon Pulmonary Angioplasty for the Treatment of Nonoperable Chronic Thromboembolic Pulmonary Hypertension: Single-Center Experience with Low Initial Complication Rate

Abstract

Purpose: To evaluate safety and efficacy of balloon pulmonary angioplasty (BPA) for nonoperable chronic thromboembolic pulmonary hypertension (CTEPH) patients during initial experience of a single center.Methods: A total of 18 CTEPH patients (5 with residual pulmonary hypertension after pulmonary endarterectomy) were treated with BPA during the period 2014 -2018 and were retrospectively reviewed. Mean age was 61 ± 19yr, 55% female, mPAP 44 ± 12 mmHg, CO 4.3 ± 1.0 l/min, PVR 8.4 ± 3.6 WU. Subjects were evaluated by NYHA functional class, 6-min walk distance, NT-proBNP, echocardiography and right heart catheterization, before and after completions of BPA.Results: A total of 91 procedures were performed with a median number of 4 (2 -8) BPA sessions per patient. There were no death or major complications requiring extracorporeal support or (non)-invasive ventilation. The most common complication was self-limiting hemoptysis (3%). According to SIR classification, 4 mild, 4 moderate and 1 severe adverse events were noted. Invasive hemodynamics significantly improved with a cardiac index increase of 15% (p=0.0333), decrease of mean pulmonary artery pressure of 30% (p = 0.0013) and pulmonary vascular resistance of 45% (p = 0.0048), respectively. Stroke volume index (p = 0.0171) and pulmonary arterial compliance (p = 0.0004) were also significantly enhanced. Conclusion:BPA significantly improves cardiopulmonary hemodynamics with an acceptable safety profile. Further studies assessing the long-term efficacy of BPA are required.

Change in pulmonary arterial compliance and pulmonary pulsatile stress after balloon pulmonary angioplasty

“…Magoń et al (21) showed that C PA increased from 1.02 (0.70 to 1.39) to 2.08 (1.49 to 2.39) mL/mm Hg (p<0.001) after successful BPA in 17 patients. Godinas et al (22) evaluated 18 patients with CTEPH and reported an increase in C PA form 1.30±0.51 to 2.24±0.96 mL/mm Hg (p<0.001). None of these studies attempted to elucidate the potential contribution of C PA on improvement in functional outcomes.…”

“…Successful BPA can increase exercise capacity and quality of life and also decrease the requirement for supplemental oxygen therapy and the need for costly PAH-specific drug therapies (6,9). Several recent publications have also shown an increase in C PA with BPA (20)(21)(22). Wiedenroth et al (20) assessed C PA in 10 patients undergoing BPA and reported an increase from 3.2±2.1 to 4.1±1.7 mL/mm Hg (p=0.027).…”

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Clinical Outcomes

“…European centres reported significant changes in outcomes, regarding both efficacy and safety, as a consequence of learning curves. 7,[30][31][32][33][34][35][36][37] More lesions are addressed per session and chronic total occlusions are treated, conferring particular benefit. [38][39][40][41] A direct comparison between BPA and medical treatments with riociguat in the RACE trial (NCT02634203) illustrated the greater efficacy of BPA (at week 26, geometric mean PVR decreased to 41% of baseline in the BPA group, compared with 68% of baseline in the riociguat group), albeit at the price of procedure-related complications.…”

Update on balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension

“…Since 2013, the Japanese technique was taught across Europe and all large CTEPH centers started their own BPA programs. European centers reported significant changes in outcomes, regarding both efficacy and safety, as a consequence of learning curves [13,14,17,[50][51][52][53][54][55]. More lesions are addressed per session [56], and CTOs are treated [57,58], conferring particular benefit [18 && ].…”