Safety and efficacy of percutaneous transluminal pulmonary angioplasty in elderly patients

Yanagisawa, Ryoji; Kataoka, Masaharu; Inami, Toru; Shimura, Nobuhiko; Ishiguro, Haruhisa; Fukuda, Keiichi; Yoshino, Hideaki; Satoh, Tsuyoshi

doi:10.1016/j.ijcard.2014.05.011

Cited by 52 publications

(33 citation statements)

References 29 publications

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“…Despite significantly worse haemodynamic parameters at baseline, patients managed with interventional therapies (PEA or BPA) had significantly superior survival at 5 years than those treated medically (98% versus 64%, respectively; p<0.0001). The efficacy and safety of BPA were similar in younger (<65 years) and older (⩾65 years) patients [23]. Data comparing outcomes of PEA in operable patients with those of BPA in inoperable patients suggest that the efficacy and safety of the two procedures are similar in their target cohorts [35].…”

Section: History Evolution and Evidence For Bpamentioning

confidence: 92%

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Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

et al. 2017

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Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA) is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH.

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Section: History Evolution and Evidence For Bpamentioning

confidence: 92%

“…Published studies of BPA are discussed below and summarised in table 1 [9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]43]. The first full report was published in 2001 by FEINSTEIN et al [15] in the USA, describing 18 patients with inaccessible or "nonsurgical" CTEPH.…”

Section: History Evolution and Evidence For Bpamentioning

confidence: 99%

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

et al. 2017

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“…Both reports mentioned specific complications related to this procedure. Meanwhile, several Japanese centres gained their own experience in BPA using slightly different methodologies and claimed reduced complication rates while maintaining high efficacy [7][8][9][10][11][12][13][14]. We started to perform BPA in non-operable CTEPH patients in 2013 [15,16], motivated by their expected poor survival compared with those offered surgical PEA [2].…”

Section: Introductionmentioning

confidence: 99%

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Kurzyna¹,

Darocha²,

Pietura³

et al. 2017

Kardiol Pol

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A b s t r a c t Background and aim:To assess the safety and efficacy of a refined balloon pulmonary angioplasty (BPA) strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods: There were 157 BPA sessions performed in 56 CTEPH patients (47 non-operable, nine after pulmonary endarterectomy; aged 58.6 ± 17.9 years; 28 females) with severely impaired pulmonary haemodynamics (mean pulmonary artery pressure [mPAP]: 51.3 ± 12.2 mm Hg, pulmonary vascular resistance [PVR]: 10.1 ± 3.9 Wood Units). The first 50 sessions aimed to recanalise chronic occlusions and prevent reocclusion with aggressive anticoagulation. The next 107 sessions aimed to relieve "web" and "ring" lesions using reduced tip load guidewires and less intensive anticoagulation.Results: There was significant reduction in haemoptysis (22% vs. 7%, p = 0.01), vessel injury (30% vs. 13%, p = 0.01), and reperfusion pulmonary injuries (22% vs. 4%, p = 0.01) after changing the BPA strategy. Mortality at 14 days was also reduced (6% vs. 0%; p = 0.05). The cumulative survival rate was 94.6% at 24 months after the first BPA, which was more favourable than medically treated historic controls. In the 31 patients with > 3 BPA sessions, there was significant reduction of PVR (10.3 ± 3.7 vs. 5.9 ± 2.8 Wood Units; p = 0.01), mPAP (50.7 ± 10.8 vs. 35.6 ± 9.3 mm Hg; p = 0.01) and improvement in World Health Organisation functional class (3.19 ± 0.48 vs. 1.97 ± 0.80; p < 0.001).Conclusions: Balloon pulmonary angioplasty improves haemodynamics and outcome but requires refined strategy to limit early complication rate.

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“…14 In the past decade, we and others reported that BPA improves the hemodynamics, cardiac function and prognosis of distal-type CTEPH without severe complications. [15][16][17][18][19][20] However, the effects of BPA on oxygenation in patients with inoperable CTEPH remain to be elucidated.…”

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confidence: 99%

Effects of Balloon Pulmonary Angioplasty on Oxygenation in Patients With Chronic Thromboembolic Pulmonary Hypertension　– Importance of Intrapulmonary Shunt –

Aoki

Sugimura

Nochioka

et al. 2016

Circ J

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Background: Although balloon pulmonary angioplasty (BPA) improves the hemodynamics and prognosis of patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), the mechanisms of improvement in oxygenation remain to be elucidated. Methods and Conclusions:These results indicated that BPA improved not only pulmonary hemodynamics but also oxygenation with a resultant decrease in intrapulmonary shunt. (Circ J 2016; 80: 2227 -2234

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Safety and efficacy of percutaneous transluminal pulmonary angioplasty in elderly patients

Cited by 52 publications

References 29 publications

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Effects of Balloon Pulmonary Angioplasty on Oxygenation in Patients With Chronic Thromboembolic Pulmonary Hypertension　– Importance of Intrapulmonary Shunt –

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Safety and efficacy of percutaneous transluminal pulmonary angioplasty in elderly patients

Cited by 52 publications

References 29 publications

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Effects of Balloon Pulmonary Angioplasty on Oxygenation in Patients With Chronic Thromboembolic Pulmonary Hypertension – Importance of Intrapulmonary Shunt –

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Effects of Balloon Pulmonary Angioplasty on Oxygenation in Patients With Chronic Thromboembolic Pulmonary Hypertension　– Importance of Intrapulmonary Shunt –