Balloon pulmonary angioplasty is effective for treating peripheral‐type chronic thromboembolic pulmonary hypertension in elderly patients

Yamagata, Yuriko; Ikeda, Satoshi; Nakata, Tomoo; Yonekura, Tsuyoshi; Koga, Seiji; Muroya, Takahiro; Koide, Yuji; Kawano, Hiroaki; Maemura, Koji

doi:10.1111/ggi.13224

Cited by 17 publications

(10 citation statements)

References 15 publications

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“…1). Of these, 11 studies presented outcomes for 755 patients with inoperable CTEPH treated with BPA (Table 1) 8,[22][23][24][25][26][27][28][29][30][31] . Twenty-three studies reported outcomes in 849 patients with inoperable CTEPH treated with pulmonary vasodilators (Table 1) 10-12,32-51 .…”

Section: Resultsmentioning

confidence: 99%

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Comparison of Balloon Pulmonary Angioplasty and Pulmonary Vasodilators for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Kalra

Duval

Thenappan

et al. 2020

Sci Rep

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treatment options for chronic thromboembolic pulmonary hypertension (ctepH) that is not amenable to thromboendarterectomy or is recurrent/persistent after thromboendarterectomy (inoperable CTEPH) include pulmonary vasodilators or balloon pulmonary angioplasty (BPA). We compared efficacy and safety outcomes of BpA with or without pulmonary vasodilators to pulmonary vasodilator therapy alone in patients with inoperable ctepH. observational and randomized trial data reporting outcomes for >5 patients with inoperable CTEPH were sought. Single-arm random effects meta-analyses were performed. The primary outcome was change in six-minute walk distance (6MWD). Secondary outcomes included safety; World Health organization functional class (WHo fc); and change in mean pulmonary arterial pressure (mpAp), pulmonary vascular resistance (pVR), and cardiac index. thirtyfour studies with 1604 patients were eligible for analyses. Both treatments resulted in significant improvement in 6MWD (71.0 meters, 95% CI: 47.4-94.5 meters with BPA versus 47.8 meters, 95% CI: 34.5-61.2 meters with pulmonary vasodilators), PVR [−3.1 Wood Units (WU), 95% CI: −4.9 to −1.4 WU versus −1.6 WU, 95% CI: −2.4 to −0.8 WU] and mPAP (−14.8 mmHg, 95% CI: −18.2 to −11.5 mmHg versus −4.9 mmHg, 95% CI: −6.9 to −2.8 mmHg). Cardiac index was similar and most patients were WHo fc ii and iii after their respective interventions. More complications occurred in the BpA arm. In conclusion, BPA and pulmonary vasodilators both improve 6MWD and hemodynamics in patients with inoperable CTEPH. While BPA may offer greater functional and hemodynamic improvements, this technique carries the accompanying risks of an invasive procedure. Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by macrovascular obstruction due to thromboemboli with an accompanying small vessel pulmonary arteriopathy 1. Pulmonary thromboendarterectomy is the gold standard treatment for CTEPH with numerous centers of excellence worldwide 2,3. However, over 40% of CTEPH patients are ineligible for pulmonary thromboendarterectomy, due to a combination of technical inaccessibility of thromboemboli, poor surgical candidacy, patient choice, or recurrent/persistent pulmonary hypertension after the operation 4,5. CTEPH patients who are not amenable to thromboendarterectomy, develop CTEPH recurrence after thromboendarterectomy, or have persistent CTEPH despite thromboendarterectomy (inoperable CTEPH) have worse outcomes than patients who successfully undergo operative intervention 6,7. In view of this, new treatments have emerged for this patient population. Balloon pulmonary angioplasty (BPA) is a percutaneous approach that employs sequential pulmonary artery angioplasty to relieve the macrovascular obstruction associated with CTEPH 6. This approach improves exercise capacity and hemodynamics 8. Furthermore, pulmonary vasodilators

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Section: Resultsmentioning

confidence: 99%

“…This is consistent with our results. However, Phan et al 's investigation did not include several key studies pertaining to BPA 8,[22][23][24][25][26][27][28][29] and pulmonary vasodilators 12,33,34,39,43,46 . Wang et al also compared riociguat to BPA in patients with inoperable CTEPH 58 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Balloon Pulmonary Angioplasty and Pulmonary Vasodilators for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Kalra

Duval

Thenappan

et al. 2020

Sci Rep

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“…However, that study included only 31 patients and chose a relatively young age for identifying elderly patients (65 years). Two more recent studies in elderly patients have confirmed the effectiveness of BPA, although they included only 10 patients aged ≥75 years ( 9 ) and eight patients aged ≥70 years ( 10 ). A French study that compared BPA and PEA results in patients aged ≥80 years also showed good results in the 21 patients who underwent BPA ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients

Martín

Melón

Gonzalez‐Trevilla

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAdvanced age, frailty, and age-related comorbidities are the major causes of pulmonary endarterectomy disqualification in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) is an attractive and less invasive therapy for elderly patients. However, information about the safety, procedure tolerance, and effectiveness of BPA in elderly patients is limited.Objective and methodsWe aimed to analyze the safety, tolerance, and efficacy of BPA in CTEPH patients aged ≥70 years. This observational, descriptive, and retrospective series included consecutive patients aged ≥70 years, who underwent completed or interrupted BPA programs at a pulmonary hypertension reference center between May 2013 and May 2022.ResultsWe enrolled 155 patients in our institution's BPA program. Among these, 33 patients were aged ≥70 years (mean age, 76.4 years; women, 75.8%) and had finished or interrupted BPA programs. In this cohort, we performed 116 BPA procedures (average, 3.6 ± 1.8 sessions/patient). Among the 33 patients, 19 (57.6%) completed treatment for all lobes, while the BPA program was interrupted in the remaining 14 (42.4%). Among all 33 patients, BPA was associated with a significant reduction in mean pulmonary arterial pressure (39.2 ± 9.3 vs. 32.8 ± 8.8 mmHg; p < 0.001) and pulmonary vascular resistance (6.7 ± 3.1 vs. 4.4 ± 2.0 WU; p < 0.001), along with an improvement in the cardiac index (2.5 ± 0.6 vs. 2.8 ± 0.7 L/min/m2; p = 0.04) with significant reductions in the N-terminal prohormone of brain natriuretic peptide level (pre-BPA, 353 pg/mL [207–1,960 pg/mL] vs. post-BPA, 167 pg/mL [73–629 pg/mL]; p = 0.03). The patients' functional class improved, and pulmonary hypertension-targeting drug requirements were significantly reduced. The pulmonary injury appeared in 3.4% of the 116 procedures, of which 50% were of grade 2. No patient of ≥70 years had grade 5 pulmonary injury. One periprocedural mortality was recorded (3%), and the median follow-up period was 2.8 years. The survival rate of the entire cohort at 1 and 3 years was 90.5 and 82.8%, respectively.ConclusionBPA is an effective and safe approach in patients aged ≥70 years. It significantly improves patients' functional class, hemodynamic, and biomarkers, and reduces their pulmonary hypertension-targeting medical therapy requirements. These successes were achieved even though a significant percentage of patients did not complete the therapy. The rates of procedural complications and periprocedural mortality were low. Survival at 1 and 3 years was good in comparison to that of younger patients undergoing BPA.

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“…BPA is a promising treatment for peripheral-type CTEPH and inoperable CTEPH patients, with a better prognosis regardless of age. 12 , 18 Furthermore, several reports have shown that BPA improves QoL. Darocha et al reported that baseline QoL in patients with CTEPH was significantly worse than in the healthy population and, after a series of BPA procedures, QoL improved significantly on all scales, as well as on scales normalized relative to the healthy population, except for pain experience.…”

Section: Discussionmentioning

confidence: 99%

“…11 Patients were considered to have a psychiatric disorder if they had been diagnosed by psychiatrists or had taken antipsychotic agents. 12 …”

Section: Methodsmentioning

confidence: 99%

Effect of Living Environment Factors on Quality of Life in Patients With Chronic Thromboembolic Pulmonary Hypertension After Completion of Balloon Pulmonary Angioplasty　― A Cross-Sectional Study ―

et al. 2021

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Background: This study investigated factors related to quality of life (QoL) in patients with chronic thromboembolic pulmonary hypertension who completed balloon pulmonary angioplasty (BPA). Methods and Results:Patient QoL and living environment after BPA were evaluated prospectively using the 5-level EQ-5D questionnaire and International Physical Activity Questionnaire Environmental Module (IPAQ-E), respectively. Patients were mailed copies of both surveys. In addition, we reviewed patient charts and collected retrospective clinical data. Relationship between the clinical data and QoL and environmental living factors were investigated. Of the 33 subjects mailed the surveys, sufficient responses were obtained from 22 (71%). Spearman's rank correlation coefficient showed that psychiatric disorders (r=−0.6865, P<0.01) and IPAQ-E Question 5 (r=0.5192, P=0.02), Question 6 (r=0.5265, P=0.02), and Question 13 (r=0.4552, P=0.04) were significantly correlated with EQ-5D scores after BPA. Conclusions:A living environment that was difficult to walk around was associated with a worse QoL. A multidisciplinary approach will be required to improve QoL even after completion of BPA treatment.

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Balloon pulmonary angioplasty is effective for treating peripheral‐type chronic thromboembolic pulmonary hypertension in elderly patients

Abstract: BPA is an effective treatment for peripheral-type CTEPH regardless of age; however, higher age, N-terminal pro-brain natriuretic peptide values before treatment and an underlying psychiatric disorder might be associated with minor complications. Geriatr Gerontol Int 2018; 18: 678-684.

Cited by 17 publications

References 15 publications

Comparison of Balloon Pulmonary Angioplasty and Pulmonary Vasodilators for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Comparison of Balloon Pulmonary Angioplasty and Pulmonary Vasodilators for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients

Effect of Living Environment Factors on Quality of Life in Patients With Chronic Thromboembolic Pulmonary Hypertension After Completion of Balloon Pulmonary Angioplasty　― A Cross-Sectional Study ―

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Balloon pulmonary angioplasty is effective for treating peripheral‐type chronic thromboembolic pulmonary hypertension in elderly patients

Abstract: BPA is an effective treatment for peripheral-type CTEPH regardless of age; however, higher age, N-terminal pro-brain natriuretic peptide values before treatment and an underlying psychiatric disorder might be associated with minor complications. Geriatr Gerontol Int 2018; 18: 678-684.

Cited by 17 publications

References 15 publications

Comparison of Balloon Pulmonary Angioplasty and Pulmonary Vasodilators for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Comparison of Balloon Pulmonary Angioplasty and Pulmonary Vasodilators for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients

Effect of Living Environment Factors on Quality of Life in Patients With Chronic Thromboembolic Pulmonary Hypertension After Completion of Balloon Pulmonary Angioplasty ― A Cross-Sectional Study ―

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Effect of Living Environment Factors on Quality of Life in Patients With Chronic Thromboembolic Pulmonary Hypertension After Completion of Balloon Pulmonary Angioplasty　― A Cross-Sectional Study ―