Pulmonary Endarterectomy (PEA) vs. Balloon Pulmonary Angioplasty (BPA) in Chronic Thrombo-Embolic Pulmonary Hypertension (CTEPH): Comparison of Improvements in Hemodynamics and Functional Capacity

Abstract

Purpose: While the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) is an emerging option for inoperable patients. Data comparing improvements in hemodynamics and functional capacity of these treatment modalities are scarce. Methods: In a single center prospective patient cohort, we compared hemodynamics by right heart catheterization and exercise by cardiopulmonary exercise testing (CPET) at admission and 5 months ( §14 days) following treatment. Comprehensive evaluation and selection for PEA or BPA was performed by an expert CTEPH team. Results: With similar patient characteristics and a mean age of 60 years, the two groups consisted of 96 consecutive patients who were treated with PEA (n=42) or BPA (n=54). A mean number of 4.6 [2-11] BPA procedures per patient were performed in the BPA group. Eight patients who were initially treated with PEA later received BPA due to residual pulmonary hypertension. At baseline, no significant between-group differences were observed regarding hemodynamics or exercise capacity. At follow up, PEA reduced mPAP and PVR to significantly lower levels than BPA. However, there were no significant between-group differences regarding improvements in cardiac output, central venous oxygen saturation, or exercise capacity. Conclusion: In our experience, PEA improves pulmonary arterial pressure and pulmonary arterial vascular resistance to significantly lower levels than with BPA. Nevertheless, with similar improvements in cardiac output and mixed venous oxygen saturation, exercise capacity increased to the same extent in both Groups.

Emerging Role of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease—Insights from the 2022 ESC Guidelines

“…Both BPA and PEA significantly reduced mPAP (from 43 ± 12 mmHg to 31 ± 9 mmHg; p < 0.001 and from 46 ± 11 mmHg at baseline to 28 ± 13 mmHg at follow-up; p < 0.001) and PVR (from 544 ± 322 dyn s cm −5 to 338 ± 180 dyn s cm −5 ; p < 0.001 and from 686 ± 347 dyn s cm −5 to 281 ± 197 dyn s cm −5 ; p < 0.001), with significantly lower reductions for both parameters after PEA. There were no significant differences between BPA and PEA regarding improvements in exercise capacity [ 65 ].…”