Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension

Abstract

Background —Although pulmonary thromboendarterectomy is increasingly successful for the definitive treatment of chronic thromboembolic pulmonary hypertension (CTEPH), not all patients have surgically accessible disease. Others are poor surgical candidates because of comorbid illness. Therefore, for selected patients, we defined and implemented an alternative interventional strategy of balloon pulmonary angioplasty (BPA). Methods and Results —Eighteen patients (mean age, 51.8 years; range, 14 to 75 years) with CTEPH underwent BPA; they averaged 2.6 procedures (range, 1 to 5) and 6 dilations (range, 1 to 12). Selection of pulmonary artery segments for dilation required (1) complete occlusion, (2) filling defects, or (3) signs of intravascular webs. After an average of 36 months of follow-up (range, 0.5 to 66 months), the average New York Heart Association class improved from 3.3 to 1.8 ( P <0.001), and 6-minute walking distances increased from 209 to 497 yards ( P <0.0001). Pulmonary artery mean pressures decreased from 43.0±12.1 to 33.7±10.2 mm Hg ( P =0.007). Eleven patients developed reperfusion pulmonary edema; 3 required mechanical ventilation. Conclusions —BPA reduces pulmonary artery hypertension in patients with CTEPH and is associated with long-term improvement in New York Heart Association class and 6-minute walking distances. BPA is a promising interventional technique that warrants randomized comparison with medical therapy in CTEPH patients who are not surgical candidates.

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

“…Initial small series from Unites States and Europe reported 5-10% mortality [5,6], and Okayama recently reported 4% (4 out of 97 patients) [23]. However, when analysing the whole experience of our team, starting from the very first BPA procedure performed in Otwock in July 2013 [15,17], regardless of the subsequent changes in BPA strategy, the two-year survival of patients treated with BPA is more favourable than the historical survival of our non-operated CTEPH patients [2].…”

“…The development of BPA was far from rapid. It took 13 years from the first case report to the publication of the first series of 18 patients treated with BPA in the United States [5], and another 13 years until the results of the first European series of 20 patients was reported from Norway [6]. Both reports mentioned specific complications related to this procedure.…”

Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

“…Pulmonary endarterectomy (PEA) is a gold standard therapy7, 8; however, PEA for organized thrombus located peripherally in subsegmental pulmonary arteries was less effective and had a high perioperative mortality rate 7, 9. Presently, balloon pulmonary angioplasty (BPA) can be recommended as an established treatment for nonoperable CTEPH patients 10, 11, 12, 13, 14, 15, 16…”

Complications of pulmonary hypertension: a pictorial review

“…The reported rate of this complication is 53-61%. 19,21 A potentially fatal complication is perforation of the pulmonary arteries, resulting in haemorrhage and exanguination. This complication is less common and is reported to be up to 7%.…”