Complications of balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: Impact on the outcome

Wiedenroth, Christoph B.; Adameit, Miriam S.D.; Kriechbaum, Steffen; Ghofrani, Hossein‐Ardeschir; Breithecker, Andreas; Haas, Moritz; Roller, Fritz; Rolf, Andreas; Hamm, Christian W.; Mayer, Eckhard; Guth, Stefan; Liebetrau, Christoph

doi:10.1016/j.healun.2022.05.002

Cited by 23 publications

(38 citation statements)

References 21 publications

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“…Previous studies have identified that hemodynamics, including baseline mPAP [10,13] and PVR [8], are predictors of BPA complications, which was also confirmed in the present study. We found that mPAP outperformed PVR in predicting complications.…”

Section: Predictors Of Bpa Complicationssupporting

confidence: 90%

Development and Validation of a Nomogram for Balloon Pulmonary Angioplasty-Related Complications in Patients with Chronic Thromboembolic Pulmonary Hypertension

Li¹,

Zhang²,

Jin³

et al. 2023

Rev. Cardiovasc. Med.

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Background: Balloon pulmonary angioplasty (BPA)-related complications are not uncommon and could contribute to perioperative mortality. However, there is a lack of a prediction model for BPA-related complications. Methods: Data from consecutive patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) who underwent BPA were retrospectively analyzed. The primary outcome was BPA-related complications. The secondary outcomes were mortality and hemodynamics after BPA. Results: A total of 207 patients with 614 BPA sessions were included. Complications occurred during 63 sessions (10.26%) in 49 patients. Hemoptysis or hemosputum (6.51%) was the most common complication, whereas pulmonary reperfusion edema was rare (0.49%). Multivariable logistic regression identified that disease duration, mean pulmonary arterial pressure (mPAP) and the proportion of occlusion lesions were correlated with BPA complications. A nomogram was constructed accordingly, which had the highest area under curve (0.703) and was superior to previously reported predictors [nomogram vs. mPAP, net reclassification index (95% confidence interval (CI)), 0.215 (0.002, 0.427), p = 0.047; integrated discrimination index (95% CI), 0.059 (0.010, 0.109), p = 0.018]. The nomogram was found to be accurate based on validation and calibration (slope 0.978, Bier score 0.163). After adjusting for the number of BPA sessions in multivariable linear regression, the occurrence of complications was not associated with hemodynamic improvement after BPA. The 3-year survival was also comparable between patients with and without complications (98.0% vs. 94.8%, log-rank p = 0.503). Conclusions: The nomogram, comprising mPAP, the proportion of occlusion lesions and disease duration, could better predict BPA-related complications than previously reported single parameters. Distinctively, the occurrence of complications did not impair the beneficial impact of BPA on hemodynamics and survival. The occurrence of complications should not discourage patients from continuing BPA sessions.

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Section: Predictors Of Bpa Complicationssupporting

confidence: 90%

Development and Validation of a Nomogram for Balloon Pulmonary Angioplasty-Related Complications in Patients with Chronic Thromboembolic Pulmonary Hypertension

Li¹,

Zhang²,

Jin³

et al. 2023

Rev. Cardiovasc. Med.

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“…Patients with longer duration of disease, increased BNP, worse 6-min walk distance, and more severely elevated mPAP and PVR were more likely to develop lung injury. 20,26,27 Kawakami et al also noted complication rates varied with the lesion type. For ring-like stenoses and web lesions, complications occurred in less than 2.5% of all interventions (31/1483).…”

Section: Complicationsmentioning

confidence: 98%

“…There are characteristics of both the patient and vascular lesion morphology that may be higher risk for the development of complications. Patients with longer duration of disease, increased BNP, worse 6‐min walk distance, and more severely elevated mPAP and PVR were more likely to develop lung injury 20,26,27 . Kawakami et al also noted complication rates varied with the lesion type.…”

Section: Complicationsmentioning

confidence: 99%

“…With most vascular injury, and provided the patient can recover, PVR reduction can still be achieved despite such complications. 27…”

Section: Complicationsmentioning

confidence: 99%

“…For more severe cases of injury leading to respiratory decompensation, noninvasive or invasive mechanical ventilation support or even ECMO support may be necessary. With most vascular injury, and provided the patient can recover, PVR reduction can still be achieved despite such complications 27 …”

Section: Complicationsmentioning

confidence: 99%

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Balloon pulmonary angioplasty in the current era of CTEPH treatment: How did we get here?

Yang,

Poch,

Ang

et al. 2023

Pulm. circ.

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Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by persistent organized thromboembolic obstruction of the pulmonary arteries from incompletely resolved pulmonary embolism. The treatment of choice is pulmonary thromboendarterectomy (PTE) surgery and all patients should be evaluated for operability candidacy. Despite advancements in PTE technique allowing more segmental–subsegmental surgeries, up to a third of patients with CTEPH may still be considered inoperable. Over the past decade, there have been increasing treatment options for these inoperable CTEPH patients. Balloon pulmonary angioplasty (BPA) is a percutaneous‐based interventional treatment option for select CTEPH cases. Early BPA experiences were plagued by high complication rates, but further refinements in technique and equipment pioneered by Japan led to the worldwide spread and adoption of BPA. Multiple centers have shown that patients experience significant improvements in hemodynamics, quality of life, exercise capacity, and survival with BPA treatment. There remain many questions on best practices, but BPA has evolved into a pivotal cornerstone of CTEPH treatment.

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Safety and efficacy of balloon pulmonary angioplasty for technically operable chronic thromboembolic pulmonary hypertension

Wang,

Liu,

Tao

et al. 2023

Pulm. circ.

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Balloon pulmonary angioplasty (BPA) has been proven effective for addressing technically inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, the effectiveness of BPA in technically operable CTEPH patients who, for various reasons, did not undergo the procedure remains an area requiring exploration. This study sought to assess the safety and efficacy of BPA in such cases. We collected and reviewed data from CTEPH patients who underwent BPA in a consecutive manner. Following multidisciplinary team (MDT) decisions, patients were classified into two groups: technically inoperable (group A) and operable (group B). Group B comprised patients deemed technically suitable for pulmonary endarterectomy (PEA) but who did not undergo the procedure for various reasons. All patients underwent a comprehensive diagnostic work‐up, including right heart categorization at baseline and the last intervention. This study compared changes in hemodynamic parameters, functional capacity, and quality of life between the two groups. In total, 161 patients underwent 414 procedures at our center, with Group A comprising 112 patients who underwent 282 BPA sessions and group B comprising 49 patients who underwent 132 BPA sessions. Significantly, both groups exhibited improvements in hemodynamics, functional capacity, and quality of life. The occurrence rate of complications, including hemoptysis and lung injury, was similar [12 (63.2%) vs. 7 (36.8%), p = 0.68]. BPA demonstrated favorable outcomes in patients with proximal CTEPH who did not undergo pulmonary endarterectomy. However, the clinical impact of BPA in technically operable CTEPH was found to be less significant than in inoperable cases.

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Complications of balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: Impact on the outcome

Cited by 23 publications

References 21 publications

Development and Validation of a Nomogram for Balloon Pulmonary Angioplasty-Related Complications in Patients with Chronic Thromboembolic Pulmonary Hypertension

Development and Validation of a Nomogram for Balloon Pulmonary Angioplasty-Related Complications in Patients with Chronic Thromboembolic Pulmonary Hypertension

Balloon pulmonary angioplasty in the current era of CTEPH treatment: How did we get here?

Safety and efficacy of balloon pulmonary angioplasty for technically operable chronic thromboembolic pulmonary hypertension

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