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Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension
Quick Takes
- Balloon pulmonary angioplasty (BPA) is safe and effective in patients with chronic thromboembolic pulmonary hypertension (CTEPH).
- Long-term follow-up data are needed to better understand incidence and risk of re-occlusion after BPA.
- Future randomized controlled trials will also inform patient selection for BPA.
- Early experience with BPA from the US is similar to data published from other centers worldwide.
Study Questions:
What is the safety and efficacy of balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH)?
Methods:
This is a retrospective observational cohort of patients undergoing BPA at a single US center.
Results:
A total of 211 BPA sessions were performed on 77 patients (average 2.7 ± 1.7 sessions/patient). The mean age of the patients was 62 ± 14.1 years, and 40 (51.9%) were female. Twenty-one (27.3%) patients had undergone prior surgical pulmonary thromboendarterectomy (PTE), 33 (42.9%) had inoperable CTEPH, 11 (27.3%) were deemed to be prohibitively high surgical risk due to comorbidities, and two (2.6%) declined PTE despite proximal disease. After BPA, the mean pulmonary vascular resistance improved by 26% (6.5 ± 3.4 to 4.8 ± 2.9 Wood units, p < 0.001). The mean 6-minute walk distance improved by 71.7 m (p < 0.001) and World Health Organization (WHO) functional class improved by one point (p < 0.001). There was one death related to reperfusion lung injury. Ten sessions (4.7%) were complicated by hemoptysis. Independent factors associated with improved functional and hemodynamic response included preprocedural use of riociguat, reduced baseline pulmonary artery compliance, and >3 BPA sessions/patient.
Conclusions:
This single-center study from the United States shows BPA in patients with CTEPH was relatively safe and was associated with significant improvements in pulmonary hemodynamics and functional capacity.
Perspective:
This experience highlights successful implementation of BPA at a US CTEPH center. These results are consistent with previously published reports of BPA from other centers worldwide. These reports continue to demonstrate improvements in functional and hemodynamic parameters, as well as low complication rates, that are comparable with those reported based on multicenter registries.
Clinical Topics: Cardiac Surgery, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Aortic Surgery, Cardiac Surgery and Heart Failure, Acute Heart Failure, Pulmonary Hypertension, Interventions and Vascular Medicine, Hypertension
Keywords: Angioplasty, Balloon, Cardiac Surgical Procedures, Endarterectomy, Heart Failure, Hemoptysis, Hypertension, Pulmonary, Pulmonary Embolism, Reperfusion, Thromboembolism, Vascular Diseases
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