Extensive revascularisation by balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension beyond haemodynamic normalisation

Abstract

ERBPA targeting residual stenoses can safely ameliorate symptoms and exercise capacity by additional improvement of hemodynamics. The results encourage us to optimize the current BPA goal to be more aggressive.

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

“…This strategy efficiently improved pulmonary perfusion, achieving significantly better hemodynamics and exercise capacity. Even though both residual lesions in subsegmental arteries and arteriopathy in small vessels could cause residual PH, it is important to perform extensive revascularization for residual lesions beyond normalization of hemodynamics as the ideal goal of hybrid therapy 22. Our hybrid strategy highlights the definite efficacy of lung perfusion recovery (Table 7) by treating subsegmental lesions on symptom and exercise capacity.…”

“…In contrast, our BPA targets mainly subsegmental arteries (Table 5). Our strategy for BPA was to treat all recognized lesions on pulmonary angiography as shown in our previous report of extensive revascularization by BPA 22. This strategy efficiently improved pulmonary perfusion, achieving significantly better hemodynamics and exercise capacity.…”

“…The 10 patients in the hybrid group had residual symptoms and residual lesions, maintained activities of daily living, and accepted informed consent. Because we previously reported the clinical utility of extensive revascularization by BPA beyond normalization of hemodynamics,22 our inclusion criteria for additional BPA in this study was also determined to be patients with residual symptoms and confirmation of recognized pulmonary lesions for BPA regardless of residual PH. We compared the hybrid group with the other 10 residual‐symptom patients (PEA group) who followed up without additional BPA.…”

Efficacy and safety of balloon pulmonary angioplasty for residual pulmonary hypertension after pulmonary endarterectomy

“…Our results (Table 2) suggest that there were residual lesions after PEA requiring revascularisation that is as extensive as that needed for inoperable BPA-adapted lesions. Extensive revascularisation using BPA for all PAG-recognised lesions has been reported to efficiently improve pulmonary perfusion, haemodynamic parameters, and exercise capacity [25,34]. However, more peripheral lesions might have an increased risk of wire or balloon perforation [31].…”

Pulmonary Endarterectomy and Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension ― Similar Effects on Health-Related Quality of Life ―

“…In our previous reports, both extensive revascularization by BPA and sequential hybrid therapy with PEA and additional BPA contributed to amelioration of symptoms and exercise capacity in patients with CTEPH. 13,14 It can therefore be hypothesized that additional BPA in addition to PEA or standard BPA might lead to better HRQOL. Further investigation is required to elucidate whether additional BPA can contribute to better HRQOL in patients previously treated with PEA or BPA.…”