Advances in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

Abstract

Balloon pulmonary angioplasty (BPA) is an emerging treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who have inoperable, segmental/subsegmental disease, or residual disease after pulmonary endarterectomy (PEA). In the past decade, advances in the techniques for BPA have led to better clinical outcomes with improvements in hemodynamics, pulmonary perfusion, exercise tolerance, functional capacity, and quality of life. We present the experience with BPA at our University, the largest CTEPH center in the world, followed by reviewing the published data regarding the efficacy and safety of BPA in patients with CTEPH. There is increasing evidence to support that the initial hemodynamic improvement is sustained for ≥3 years after the procedure. Although infrequent, complications observed with BPA are associated with pulmonary vascular injury or rarely reperfusion pulmonary edema. As the technique for percutaneous pulmonary artery revascularization has improved, the procedural risk and complications have continued to decrease. This promising technique continues to develop and future research is required to demonstrate the long-term benefits of BPA, standardize the technique, and define a uniform institutional infrastructure for providing BPA as a part of the treatment of CTEPH.

Emergent balloon pulmonary angioplasty in a patient with central‐type chronic thromboembolic pulmonary hypertension with cardiac shock

“… 1 However, the PAP increases due to complications such as pulmonary vessel injury and reperfusion pulmonary edema. 6 Moreover, its severity is exacerbated by a high mean PAP. 6 Therefore, under such critical conditions, BPA must be performed without any complications.…”

“… 6 Moreover, its severity is exacerbated by a high mean PAP. 6 Therefore, under such critical conditions, BPA must be performed without any complications. Kawakami et al established the angiographic lesion classification, prediction for success, and complication rate of BPA.…”

Recognizing pulmonary hypertension following pulmonary thromboendarterectomy: A practical guide for clinicians

“…37 While early studies with BPA showed benefit, the rate of complications from the procedure was initially high. 38 Mahmud et al 35 recently reviewed advancements in BPA studies to date that provide evidence of both short-and long-term improvement, and a reduction in the rate of complications, as techniques and expertise evolve. Recent work from a high-volume BPA center demonstrates an overall success rate of 81% for recanalization of vascular lesions, with the number of successfully treated lesions predicting hemodynamic benefit.…”

Heart-Rate Recovery at 1 Min After Exercise Predicts Response to Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension

“…Over the past decade, refined balloon pulmonary angioplasty (BPA) is emerging as an alternative option for inoperable CTEPH. Increasing evidences suggest that BPA could significantly improve hemodynamics, exercise tolerance and pulmonary function (6,7).…”