TCT-92 Short- And Long-Term Remodeling of Pulmonary Arteries After Balloon Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension

Abstract

BACKGROUND Pulmonary endarterectomy (PEA) is a gold standard therapy that can dramatically reduce pulmonary artery pressure (PAP) and improve the prognosis on chronic thromboembolic pulmonary hypertension (CTEPH). However, residual pulmonary hypertension or persistent symptoms even after PEA are still the clinical issues to be solved. We investigated whether additional balloon pulmonary angioplasty (BPA) after PEA was effective.METHODS Since August 2009 until June 2016, 23 patients underwent PEA at Kobe University Hospital. Seven patients with residual pulmonary hypertension or symptom underwent additional BPA. RESULTSThe period from PEA to additional BPA was 8.3 AE 8.3 months and the number of BPA sessions was 2.4 AE 0.9. In 7 patients who underwent additional BPA after PEA, mean PAP and pulmonary vascular resistance (PVR) had significantly improved by PEA (39.3 AE 6.0 to 27.9 AE 10.1 mmHg p<0.01, 996 AE 447 to 473 AE 255 dyne･sec･cm-5 p¼0.02), and improved further (to 19.9 AE 7.9 mmHg p¼0.01 ,to 183 AE 96 dyne･sec･cm-5 p¼0.01) by additional BPA. Before PEA, 2 patients were NYHA/WHO functional class II and 5 patients were class III. Hybrid therapy improved NYHA/WHO functional class (3 patients classI, 3 patients classII, 1 patients classIII p¼0.05)( Figure). No patient died and had severe complication needed mechanical ventilator and extracorporeal membrane oxygenation during whole study period.CONCLUSION Although PEA for CTEPH had improved pulmonary hemodynamic profiles, additional BPA could improve them further. Additional BPA is an effective and safe treatment for residual pulmonary hypertension or persistent symptom. CATEGORIES ENDOVASCULAR: Peripheral Vascular Disease and InterventionTCT-91 Efficacy of aggressive balloon pulmonary angioplasty on chronic thromboembolic pulmonary hypertension beyond normalized mean pulmonary arterial pressure

Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension ― A Systematic Review and Meta-Analysis ―

“…Thus, the final cohort included 14 studies with a total population of 725 patients ( Supplementary Table 1C). 12,23,28,35,42,[44][45][46][47][48][49][50][51]52 Hemodynamic Parameters Median of the mean mPAP was 43 mmHg (interquartile range (IQR) 40.5-49.25 mmHg) before BPA and 32.5 mmHg (IQR 25-33.5 mmHg) after BPA (Figure 2A). Median of the mean CI of included studies was 2.35 L/min/m 2 (IQR 2.23-2.70 L/min/m 2 ) before BPA and 2.62 L/min/m 2 (IQR 2.5-2.92 L/min/m 2 ) after BPA ( Figure 2B).…”