Metrics for Success of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension

Saia, Francesco; Dardi, Fabio; Taglieri, Nevio; Manes, Alessandra; Guarino, Daniele; Galiè, Nazzareno; Palazzini, Massimiliano

doi:10.1007/978-3-030-95997-5_10

Cited by 2 publications

(3 citation statements)

References 34 publications

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“…The patient’s clinical status is still consistently changing during this lengthy process. Matsubara et al 17 reported that deteriorated hemodynamics or symptoms were identified in approximately 50% of patients who failed to reach mean pulmonary arterial pressure <25 mmHg and oxygen saturation >95%, which is consistent with our results. Theoretically, the entire BPA procedure should be completed in a limited time to optimize patients’ prognosis.…”

Section: Discussionsupporting

confidence: 93%

Optimal short-term outcomes in balloon pulmonary angioplasty: the minimum frequency of three sessions annually

Li,

Yang,

Zhang

et al. 2024

Ther Adv Respir Dis

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Background: Balloon pulmonary angioplasty (BPA) is typically performed in a sequential manner. Objectives: This study aimed to determine the lowest frequency of BPA for patients who could not reach treatment goals in a short period. Design: Retrospective cohort. Methods: We retrospectively enrolled 186 BPA-treated patients diagnosed with chronic thromboembolic pulmonary hypertension. According to the accumulative number of performed BPA sessions or treated pulmonary vessels or the ratio of the number of treated pulmonary vessels/the number of baseline lesions (T/P) prior to the initial occurrence of clinical outcome or censored date, we divided patients into different groups. The principal outcome was clinical worsening. Results: After stratifying patients by the number of performed BPA sessions, most baseline parameters were comparable among groups. During follow-up, 31 (16.7%) of 186 patients experienced clinical worsening. The 6-month cumulative clinical worsening-free survival rates of ⩾2 performed sessions group were significantly higher than that of 1 performed session group. The 12-month cumulative rates of clinical worsening-free survival exhibited a declining pattern in the subsequent sequence: ⩾3, 2, and 1 performed BPA sessions, and this trend persisted when follow-up time exceeded 12 months. The 6-, 12-, and 24-month cumulative clinical worsening-free survival rates were comparable between patients with 3 and ⩾4 performed BPA sessions. Similar results were also observed when stratifying patients by the accumulative number of treated pulmonary vessels (⩽8, 9–16, ⩾17) and T/P (⩽0.789, 0.790–1.263, ⩾1.264). Conclusion: To achieve optimal short-term outcomes, patients might need to undergo ⩾2 BPA sessions or have ⩾9 pulmonary vessels treated or have T/P ⩾0.790 within 6 months, and undergo ⩾3 BPA sessions or have ⩾17 pulmonary vessels treated or have T/P ⩾1.264 within 12 months.

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Section: Discussionsupporting

confidence: 93%

Optimal short-term outcomes in balloon pulmonary angioplasty: the minimum frequency of three sessions annually

Li,

Yang,

Zhang

et al. 2024

Ther Adv Respir Dis

View full text Add to dashboard Cite

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“…Despite the considerable achievements observed with BPA in pulmonary artery revascularization, total occlusion remains a challenge and many interventionists are reluctant to address occlusive lesions 4 . Among all the treated lesions, attempts on total occlusion account for less than 5% 5 . Within the limited experience in addressing total occlusion, the reported success rate is as low as 52.2% and is accompanied by a high complication rate.…”

Section: Introductionmentioning

confidence: 99%

“… 4 Among all the treated lesions, attempts on total occlusion account for less than 5%. 5 Within the limited experience in addressing total occlusion, the reported success rate is as low as 52.2% and is accompanied by a high complication rate. Conversely, compared with other types of lesions, addressing occlusive lesions yields the greatest haemodynamic benefit.…”

Section: Introductionmentioning

confidence: 99%

Angiographic classification of total occlusion and its implication on balloon pulmonary angioplasty

Yang,

Li,

Luo

et al. 2023

ESC Heart Failure

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AimsDespite refinements in balloon pulmonary angioplasty (BPA), total occlusion remains a challenge in chronic thromboembolic pulmonary hypertension (CTEPH). Owing to their low success and high complication rates, most interventional cardiologists are reluctant to address total occlusion, and there is a paucity of literature on BPA performance in total occlusion. We aimed to classify total occlusion according to morphology and present an illustrative approach for devising a tailored treatment strategy for each distinct type of total occlusion.Methods and resultsAll patients diagnosed with CTEPH who underwent BPA between May 2018 and May 2022 at Fuwai Hospital in Beijing, China, were included retrospectively. A total of 204 patients with CTEPH who underwent BPA were included in this study. Among these, 38 occluded lesions were addressed in 33 patients. Based on the morphology, we categorized the lesions into three groups: pointed‐head, round‐head, and orifice occlusions. Pointed‐head occlusion could be successfully addressed using soft‐tip wire, round‐head occlusion warranted hard‐tip wire and stronger backup, and orifice occlusion warranted the strongest backup force. The success rates for each group were as follows: pointed‐head (95.45%), round‐head (46.15%), and orifice occlusion (33.33%), with orifice occlusion having the highest complication rate (50%). The classification of occlusion was associated with BPA success (round‐head occlusion vs. pointed‐head occlusion, OR 24.500, 95% CI 2.498–240.318, P = 0.006; orifice occlusion vs. pointed‐head occlusion, OR 42.000, 95% CI 3.034–581.434, P = 0.005).ConclusionsOcclusion morphology has a significant impact on BPA success and complication rates. A treatment strategy tailored to each specific occlusive lesion, as outlined in the present study, has the potential to serve as a valuable guide for clinical practitioners.

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Metrics for Success of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension

Cited by 2 publications

References 34 publications

Optimal short-term outcomes in balloon pulmonary angioplasty: the minimum frequency of three sessions annually

Optimal short-term outcomes in balloon pulmonary angioplasty: the minimum frequency of three sessions annually

Angiographic classification of total occlusion and its implication on balloon pulmonary angioplasty

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