Balloon Pulmonary Angioplasty as a Treatment in Chronic Thromboembolic Pulmonary Hypertension: Past, Present, and Future

Karyofyllis, Panagiotis; Demerouti, Eftychia; Papadopoulou, V.; Voudris, Vassilis; Matsubara, Hiromi

doi:10.1007/s11936-020-0807-3

Cited by 8 publications

(5 citation statements)

References 51 publications

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“…The latest treatment algorithms from the Japanese Circulation Society Joint Working Group and the European Society of Cardiology guidelines also suggest BPA for symptomatic PH after PEA [7,26]. However, there is limited evidence regarding treatments for residual PH after PEA, and it is unclear whether there are clinical or technical differences when using BPA to treat residual PH after PEA or inoperable CTEPH [27]. Therefore, we retrospectively compared BPA outcomes between patients with residual PH after PEA and those with inoperable CTEPH.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of balloon pulmonary angioplasty for residual pulmonary hypertension after pulmonary endarterectomy

Ito

Yamashita

Sasaki

et al. 2021

International Journal of Cardiology

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Background: Pulmonary endarterectomy (PEA) is the standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH), although some patients may experience residual pulmonary hypertension (PH). It is unclear whether balloon pulmonary angioplasty (BPA) is effective for residual PH after PEA. This study aimed to compare the BPA outcomes between patients with residual PH after PEA and those with inoperable CTEPH. Methods: This retrospective study compared BPA for residual PH after PEA (25 patients, 101 BPA sessions) and BPA alone for inoperable CTEPH (21 patients, 89 BPA sessions). All patients underwent right heart catheterisation and functional and laboratory tests before PEA or before and after BPA. Results: There was no difference in the number of BPA sessions per patient (4.0 ± 1.9 vs. 4.2 ± 1.9, p = 0.671). No significant differences were observed with respect to the mean pulmonary artery pressure (23.6 ± 9.1 vs. 21.9 ± 5.7 mmHg, p = 0.44), pulmonary vascular resistance (3.7 ± 0.5 vs. 2.8 ± 1.2 Wood units, p = 0.14), 6-min walking distance (392.1 ± 117.7 vs. 452.4 ± 90.1 m, p = 0.096), and World Health Organization functional class (I/II/ III/IV: 14/11/0/0 vs. 9/12/0/0, p = 0.375). Severe haemoptysis requiring embolisation was more common in the PH after PEA group (16.0% vs. 5.4%, p = 0.018). However, no patients required mechanical ventilation or extracorporeal membrane oxygenation, and there were no procedural deaths. Conclusion: Although BPA might be effective for residual PH after PEA, it was associated with a high rate of haemoptysis.

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Section: Introductionmentioning

confidence: 99%

Efficacy and safety of balloon pulmonary angioplasty for residual pulmonary hypertension after pulmonary endarterectomy

Ito

Yamashita

Sasaki

et al. 2021

International Journal of Cardiology

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“…Overall, adverse events are observed in approximately 10% of interventions in contemporary practice. A recent meta-analysis reported that the periprocedural mortality rate is 2.9% in patients undergoing BPA [3]. In a Japanese multi-centre registry, severe complications requiring mechanical ventilation were observed in 5.5% of treated patients, and the periprocedural mortality rate was 2.6% [17].…”

Section: Discussionmentioning

confidence: 99%

“…Dilation is also often associated with high rates of re-occlusion due to elastic recoil. Weakening of vessels with the coexistence of high pressure may result in pulmonary artery aneurysms, making the manipulation of catheters inside the artery very difficult in patients who have previously undergone PEA [3]. These vessels require guidewires that have a heavy tip weight and large balloon diameter, which may lead to dissection or perforation of the vessel.…”

Section: Discussionmentioning

confidence: 99%

“…However, approximately one-third of patients are ineligible for PEA because of diffuse distal lesions that are technically inaccessible during surgery or the presence of severe comorbidities that prohibit surgery. On the other hand, about half of all patients undergoing PEA have persistent PH, which is commonly mild, but sometimes moderate or severe and requiring additional treatment [2][3][4]. In addition, patients with CTEPH may develop pulmonary embolism due to ineffective anticoagulation or thrombophilia, resulting in recurrent PH, even in those who have previously undergone curative surgery.…”

Section: Introductionmentioning

confidence: 99%

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Balloon Pulmonary Angioplasty in Patients With Inoperable or Recurrent/Residual Chronic Thromboembolic Pulmonary Hypertension: A Single-Centre Initial Experience

Atas

Mutlu

Akaslan

et al. 2022

Heart, Lung and Circulation

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BackgroundPatients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) are often treated with pulmonary arterial hypertension-specific drugs. However, most of these patients remain symptomatic, despite medical treatment. Balloon pulmonary angioplasty (BPA) is an emerging therapeutic intervention for patients with inoperable CTEPH. This study aimed to report the initial experience of BPA in a tertiary referral centre for CTEPH. MethodsA total of 26 consecutive patients, who underwent 91 BPA sessions, were included in the study. All patients underwent a detailed examination, including 6-minute walking distance (6MWD), and right heart catheterisation at baseline and 3 months after the last BPA session. ResultsThe mean age of the patients was 51617 years. Fifteen (15) patients had inoperable CTEPH and 11 patients had residual or recurrent CTEPH post pulmonary endarterectomy (PEA). Functional class improved in 17 of 26 (65%) patients. The 6MWD increased from a mean 3156129 to 4116140 m (p,0.001), and NT pro-BNP reduced from a median 456 to 189 pg/mL (p=0.001). The number of patients who required supplemental oxygen decreased from 11 (42.3%) to five (19%) (p=0.031) after BPA treatment. The mean pulmonary artery pressure decreased from a mean 47.5613.4 to 38610.9 mmHg (p,0.001), the pulmonary vascular resistance decreased from a mean 9.364.7 to 5.862.8 Wood units (p,0.001), and the cardiac index increased from a mean 2.460.7 to 2.960.6 L/min/m 2 (p=0.008). ConclusionsBalloon pulmonary angioplasty improved haemodynamics, 6MWD, and functional class, and reduced the requirement for supplemental oxygen, with an acceptable risk-benefit ratio in patients with inoperable CTEPH and with residual/recurrent CTEPH.

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“…At present, we point to the importance of active BPA programs in Greece, as 17.6% of non-operable patients and 5.4% of operable patients did undergo BPA, a promising efficacious method, complementary to PEA in the treatment algorithm of CTEPH [ 21 ]. BPA is not suitable for all non-operable patients.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Management of Chronic Thromboembolic Pulmonary Hypertension in Greece. Real-World Data from the Hellenic Pulmonary Hypertension Registry (HOPE)

Demerouti

Karyofyllis

Voudris

et al. 2021

JCM

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Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare disease with poor prognosis if left untreated, characterized by pulmonary vascular bed obstruction due to unresolving thromboembolic material. The Hellenic pulmonary hypertension registry (HOPE) was launched in Greece in early 2015 and enrolls patients from all pulmonary hypertension subgroups in Greece. In total, 98 patients with CTEPH were enrolled from January 2015 until November 2019. Of these patients, 55.1% represented incident population, 50% were classified in the World Health Organization functional class II and 49% had a history of acute pulmonary embolism. The median values of pulmonary vascular resistance (PVR) and cardiac index were 7.4 (4.8) WU and 2.4 (1.0) L/min/m2, respectively, the mean diffusing capacity for carbon monoxide was 74.8 ± 20.6%, the median 6-minute walk distance was 347 (220) meters and the median value of N Terminal-pro brain natriuretic peptide was 506.0 (1450.0) pg/mL. In total, 60.2% of the patients were under pulmonary arterial hypertension-targeted therapy at the time of enrolment; specifically, riociguat was received by 35.7% of the patients and combination therapy was the preferred strategy for 16% of the patients. In total, 74 patients were evaluated for pulmonary endarterectomy (PEA), 34 (45.9%) were assessed as operable but only 23 of those (31.1%) finally underwent PEA. The remaining 40 patients were ineligible for PEA according to the operability assessment and 13 (17.6%) of them underwent balloon pulmonary angioplasty. The age of the non-operable patients was significantly higher than the operable patients (p < 0.001), while there was no significant difference with regard to the history of coagulopathies between the operable and non-operable patients (p = 0.33).

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Balloon Pulmonary Angioplasty as a Treatment in Chronic Thromboembolic Pulmonary Hypertension: Past, Present, and Future

Cited by 8 publications

References 51 publications

Efficacy and safety of balloon pulmonary angioplasty for residual pulmonary hypertension after pulmonary endarterectomy

Efficacy and safety of balloon pulmonary angioplasty for residual pulmonary hypertension after pulmonary endarterectomy

Balloon Pulmonary Angioplasty in Patients With Inoperable or Recurrent/Residual Chronic Thromboembolic Pulmonary Hypertension: A Single-Centre Initial Experience

Epidemiology and Management of Chronic Thromboembolic Pulmonary Hypertension in Greece. Real-World Data from the Hellenic Pulmonary Hypertension Registry (HOPE)

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