Status and Future Directions for Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease With and Without Pulmonary Hypertension: A Scientific Statement From the American Heart Association

Abstract

Balloon pulmonary angioplasty continues to gain traction as a treatment option for patients with chronic thromboembolic pulmonary disease with and without pulmonary hypertension. Recent European Society of Cardiology guidelines on pulmonary hypertension now give balloon pulmonary angioplasty a Class 1 recommendation for inoperable and residual chronic thromboembolic pulmonary hypertension. Not surprisingly, chronic thromboembolic pulmonary hypertension centers are rapidly initiating balloon pulmonary angioplasty programs. However, we need a comprehensive, expert consensus document outlining critical concepts, including identifying necessary personnel and expertise, criteria for patient selection, and a standardized approach to preprocedural planning and establishing criteria for evaluating procedural efficacy and safety. Given this lack of standards, the balloon pulmonary angioplasty skill set is learned through peer-to-peer contact and training. This document is a state-of-the-art, comprehensive statement from key thought leaders to address this gap in the current clinical practice of balloon pulmonary angioplasty. We summarize the current status of the procedure and provide a consensus opinion on the role of balloon pulmonary angioplasty in the overall care of patients with chronic thromboembolic pulmonary disease with and without pulmonary hypertension. We also identify knowledge gaps, provide guidance for new centers interested in initiating balloon pulmonary angioplasty programs, and highlight future directions and research needs for this emerging therapy.

The Initial Experience of Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension in Latvia

“…Consequently, there is a swift movement among chronic thromboembolic pulmonary hypertension centers to integrate BPA into their treatment offerings. Despite this momentum, the training for BPA is predominantly informal, reliant on knowledge exchange and hands-on training within peer-led educational initiatives, highlighting an urgent need for formalized training protocols [25]. While long-term data after BPA are currently lacking, and PEA may reduce the pulmonary pressures more than BPA, comparatively similar exercise tolerance improvements can be observed [24].…”

“…Technical complexities lie in successful cannulation of segmental origins due to anatomical variations, usage of guide extension catheters, and correct lesion assessment during careful selective invasive pulmonary angiography and correct pressure gradient measurements for vessels appearing angiographically patent. In patient selection, experienced multidisciplinary teams are crucial for confirming diagnosis and guiding patient management, as well evaluating the clot burden, lesion classification, and the degree of hemodynamic derangement [25].…”