Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: a multicentre registry

Darocha, Szymon; Roik, Marek; Kopeć, Grzegorz; Araszkiewicz, Aleksander; Furdal, Michał; Lewandowski, Maciej; Jacheć, Wojciech; Grabka, Marek; Banaszkiewicz, Marta; Piertrasik, Arkadiusz; Pietura, Radosław; Stępniewski, Jakub; Waligóra, Marcin; Magoń, Wojciech; Jonas, Kamil; Łabyk, Andrzej; Potępa, Michał; Fudryna, Aleksandra; Jankiewicz, Stanisław; Sławek-Szmyt, Sylwia; Mularek‐Kubzdela, Tatiana; Lesiak, Maciej; Mroczek, Ewa; Orłowska, Joanna; Peregud‐Pogorzelska, Małgorzata; Tomasik, Andrzej; Mizia‐Stec, Katarzyna; Przybylski, Roman; Podolec, Piotr; Zieliński, Dariusz; Biederman, Andrzej; Torbicki, Adam; Pruszczyk, Piotr; Kurzyna, Marcin

doi:10.4244/eij-d-21-00230

Cited by 35 publications

(46 citation statements)

References 30 publications

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“…In an international registry, among patients undergoing BPA, the mortality associated with PH was 1.8% at 32-month follow-up [18]. In the Polish BNP-PL registry, the 3-year survival rate was 92.4%; perioperative complications, such as lung damage, were reported in 6.4% of sessions [21]. Multiple treatment sessions per patient are usually required to achieve clinical and hemodynamic improvement.…”

Section: Procedural Treatmentmentioning

confidence: 99%

An expert opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation on screening for chronic thromboembolic pulmonary hypertension patients after acute pulmonary embolism: Update

et al. 2022

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism (APE). Both pharmacological and invasive treatments for CTEPH are available in Poland, and awareness of the disease among physicians is growing. It has been suggested that the COVID-19 pandemic may increase the incidence of CTEPH and facilitate disease detection during more advanced stages of the illness. Thus, the Polish Cardiac Society's Working Group on Pulmonary Circulation, in cooperation with independent experts in this field, launched the updated statement on the algorithm to guide a CTEPH diagnosis in patients with previous APE. CTEPH should be suspected in individuals after APE with dyspnea, despite at least 3 months of effective anticoagulation, particularly when specific risk factors are present. Echocardiography is the main screening tool for CTEPH. A diagnostic workup of patients with significant clinical suspicion of CTEPH and right ventricular overload evident on echocardiography should be performed in reference centers. Pulmonary scintigraphy is a safe and highly sensitive screening test for CTEPH. Computed tomography pulmonary angiography with precise detection of thromboembolic residues in the pulmonary circulation is important for the planning of a pulmonary thromboendarterectomy. Right heart catheterization definitively confirms the presence of pulmonary hypertension and direct pulmonary angiography allows for the identification of lesions suitable for thromboendarterectomy or balloon pulmonary angioplasty. In this document, we propose a diagnostic algorithm for patients with suspected CTEPH. With an individualized and sequential diagnostic strategy, each patient can be provided with suitable and tailored therapy provided by a dedicated CTEPH Heart Team.

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Section: Procedural Treatmentmentioning

confidence: 99%

An expert opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation on screening for chronic thromboembolic pulmonary hypertension patients after acute pulmonary embolism: Update

et al. 2022

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“… 6 In the European multicenter prospective registry for BPA in CTEPH, 69.4% of patients received specific pharmacotherapy before the onset of BPA procedures. 7 …”

Section: Discussionmentioning

confidence: 99%

An unusual case of CTEPH treated by BPA in a patient with a single lung after cancer surgery

Darocha¹,

Kurzyna

Banaszkiewicz‐Cyganik³

et al. 2022

Pulm. circ.

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A 46-year-old man 1 year after left-sided pneumonectomy for squamous cell lung cancer presented with severely limited exercise tolerance and dyspnea corresponding to World Health Organization functional class IV (WHO Class IV).After right heart catheterization (RHC), mean pulmonary artery pressure (mPAP) was 43 mmHg and pulmonary vascular resistance (PVR) was 10.2 Wood units (WU). Arteriography revealed organized clots located at the proximal level of the right pulmonary artery, leading to a diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). The CTEPH team disqualified the patient from surgical treatment due to high perioperative risk and referred him for balloon pulmonary angioplasty (BPA) together with pulmonary hypertension-specific pharmacotherapy (sildenafil). The patient underwent a cycle of nine BPA sessions and completed treatment without complications. Follow-up showed sustained hemodynamic improvement in RHC (mPAP 23 mmHg, PVR 2.6 WU), improved physical capacity (WHO Class II), and relief of dyspnea symptoms.

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“…The main complication of BPA is lung injury (LI) which occurred in 6.4% of sessions in the Polish multicenter registry [17], in 9.1% of sessions in the French Registry [13] and in 9.4% of sessions in the Bad Nauheim report [12]. Lesion type did not predict the occurrence of pulmonary injury [18 && ], but high mean pulmonary artery pressure [13,18 && ] and operator experience [13] predicted complications.…”

Section: Thoracic Complications and Non-thoracic Complicationsmentioning

confidence: 99%

Update on balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension

Lang¹

2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewTo provide an update on balloon pulmonary angioplasty (BPA) for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH), a pulmonary vascular disease that is characterized by fibro-thrombotic material mechanically obliterating major pulmonary arteries, resulting in increased pulmonary vascular resistance (PVR), progressive pulmonary hypertension (PH) combined with a microscopic pulmonary vasculopathy [1▪▪], right ventricular (RV) failure [2] and premature death.Recent findingsData from a most recent CTEPH European registry (2015 and 2016) suggest significantly improved survival [3▪] of CTEPH patients compared with survival in the eighties [4], or with data from 2007 and 2009 [5]. Pulmonary endarterectomy (PEA) is still the gold-standard therapy for CTEPH [6,7]. However, only around two thirds of all CTEPH patients are amenable to surgery [3▪,5]. Patients not suitable for PEA and treated conservatively have a poor prognosis [8]. BPA may have a role for this particular group of patients. [9–11]. Currently, BPA programs are available in many countries, with excellent results at expert centers [12–15,16▪,17,18▪▪]. Based on recent data, BPA seems to have a greater impact on symptomatic and hemodynamic improvement than medical therapy with riociguat alone [15].SummaryThe evidence favoring BPA is growing, but there is still a lack of published controlled trials. In addition, treatment concepts including indication, technical performance, use of PH-targeted medication, and the concept of follow-up vary between centers. In addition, there is a significant learning curve impacting outcomes [13]. The data from the International BPA registry will provide answers for some of the open questions.

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Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: a multicentre registry

Cited by 35 publications

References 30 publications

An expert opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation on screening for chronic thromboembolic pulmonary hypertension patients after acute pulmonary embolism: Update

An expert opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation on screening for chronic thromboembolic pulmonary hypertension patients after acute pulmonary embolism: Update

An unusual case of CTEPH treated by BPA in a patient with a single lung after cancer surgery

Update on balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension

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