Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension

Andreassen, Arne K.; Ragnarsson, Àsgrìmur; Gude, Einar; Geiran, Odd; Andersen, Rune

doi:10.1136/heartjnl-2012-303549

Cited by 241 publications

(174 citation statements)

References 26 publications

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“…Pulmonary tissue surrounding pulmonary arteries offers little resistance to bleeding in cases of iatrogenic vascular injury. Extravasated blood may invade either the bronchial system or pulmonary interstitium [6,9,10]. Also, dilatation of a significant stenosis of a medium-sized pulmonary artery may result in local reperfusion oedema.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we thought it was imperative to obtain a significant haemodynamic effect after the first BPA sessions. The second factor was the BPA methodology used by the first European centre that published its experience [6].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Survival In Cteph According To Treatmentmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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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

Kurzyna¹,

Darocha²,

Pietura³

et al. 2017

Kardiol Pol

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A b s t r a c t Background and aim:To assess the safety and efficacy of a refined balloon pulmonary angioplasty (BPA) strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods: There were 157 BPA sessions performed in 56 CTEPH patients (47 non-operable, nine after pulmonary endarterectomy; aged 58.6 ± 17.9 years; 28 females) with severely impaired pulmonary haemodynamics (mean pulmonary artery pressure [mPAP]: 51.3 ± 12.2 mm Hg, pulmonary vascular resistance [PVR]: 10.1 ± 3.9 Wood Units). The first 50 sessions aimed to recanalise chronic occlusions and prevent reocclusion with aggressive anticoagulation. The next 107 sessions aimed to relieve "web" and "ring" lesions using reduced tip load guidewires and less intensive anticoagulation.Results: There was significant reduction in haemoptysis (22% vs. 7%, p = 0.01), vessel injury (30% vs. 13%, p = 0.01), and reperfusion pulmonary injuries (22% vs. 4%, p = 0.01) after changing the BPA strategy. Mortality at 14 days was also reduced (6% vs. 0%; p = 0.05). The cumulative survival rate was 94.6% at 24 months after the first BPA, which was more favourable than medically treated historic controls. In the 31 patients with > 3 BPA sessions, there was significant reduction of PVR (10.3 ± 3.7 vs. 5.9 ± 2.8 Wood Units; p = 0.01), mPAP (50.7 ± 10.8 vs. 35.6 ± 9.3 mm Hg; p = 0.01) and improvement in World Health Organisation functional class (3.19 ± 0.48 vs. 1.97 ± 0.80; p < 0.001).Conclusions: Balloon pulmonary angioplasty improves haemodynamics and outcome but requires refined strategy to limit early complication rate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Survival In Cteph According To Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Kurzyna¹,

Darocha²,

Pietura³

et al. 2017

Kardiol Pol

View full text Add to dashboard Cite

show abstract

“…Studies have shown no immediate improvement in haemodynamics, but during follow-up, there is evidence of a decrease in right atrial pressure and pulmonary arterial pressure and increase in cardiac output. 19,20 BPA could target distal lesions which could not be reached by PEA, usually the segmental and subsegmental pulmonary arteries. However, the lesions are still under high pressure, and patients with very poor baseline haemodynamics are prone to reperfusion oedema.…”

Section: Balloon Angioplasty Complicationsmentioning

confidence: 99%

Complications of pulmonary hypertension: a pictorial review

Mak¹,

Strickland²,

Gopalan³

2017

The British Journal of Radiology

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Pulmonary hypertension (PH) is a rare disease with a significant morbidity and mortality if untreated. The disease has a multifactorial aetiology and is often associated with insidious onset of signs and symptoms. Multimodality imaging is often required for establishing the diagnosis, evaluating the underlying haemodynamic compromise and follow-up after institution of therapy. The range of potential complications associated with PH vary widely. We aimed to summarize the imaging findings of complications that the radiologist should be familiar with.

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Chronic Thromboembolic Pulmonary Hypertension

Papamatheakis

Auger

2017

Handbook of Venous Thromboembolism

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The pulmonary hypertension (PH) and right heart dysfunction that results from chronic thromboembolic involvement of the pulmonary vascular bed is potentially curable with surgical endarterectomy. Over the past several decades, growing clinical experience has brought about increased recognition of this treatable form of PH. Moreover, advances in cardiothoracic surgical techniques have given an increasing number of patients with chronic thromboembolic PH (CTEPH) a surgical remedy with decreasing perioperative morbidity and mortality risks. The availability of pulmonary hypertensive-specific medical therapy for CTEPH patients with surgically inaccessible disease also has been a positive therapeutic advance over the past several years. However, despite this progress, chronic thromboembolic disease as a sequela of acute pulmonary emboli continues to be underappreciated. Furthermore, even if CTEPH has been appropriately diagnosed, misinterpretation of diagnostic information may lead to the inappropriate exclusion of patients from surgical consideration. This may result in the prescription of pulmonary hypertensive medical therapy in CTEPH patients with potentially surgically correctable disease. This difficulty arises from a lack of objective criteria as to what constitutes surgical chronic thromboembolic disease, which primarily is a result of the variability in surgical experience in specialty centers in the United States. Consequently, clinicians must be wary about using pulmonary hypertensive medications in CTEPH patients. Before prescription, it is important to exclude patients from surgical consideration by consulting a specialized center with expertise in this discipline.

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Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension

Abstract: BPA may offer an alternative form of treatment in selected CTEPH patients. While prognostic markers such as haemodynamics, functional capacity and biomarkers improve, significant periprocedural complications must be recognised. Randomised trials are warranted.

Cited by 241 publications

References 26 publications

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

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

Complications of pulmonary hypertension: a pictorial review

Chronic Thromboembolic Pulmonary Hypertension

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