Balloon pulmonary angioplasty vs. pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis

Zhang, Liyan; Bai, Yuping; Yan, Peijing; He, Taiping; Liu, Bin; Wu, Shanlian; Qian, Zhen; Li, Changtian; Cao, Yunshan; Zhang, Min

doi:10.1007/s10741-020-10070-w

Cited by 18 publications

(19 citation statements)

References 77 publications

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“…During the past decade, the efficacy of BPA treatment on hemodynamics and exercise capacity has been proved in a series of studies worldwide [ 15 ]. Our results of 24 CTEPH patients who finished all BPA procedures with a hemodynamic follow-up also show similar hemodynamics effect to the results achieved in European centers [ 16 , 17 ], but slightly worse than that achieved in Japan [ 18 , 19 ], possibly due to a higher level of baseline mPAP and PVR in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Bilateral versus unilateral balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension

Hong

et al. 2022

Respir Res

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Background To evaluate the safety and efficacy of bilateral balloon pulmonary angioplasty (BPA) as compared with unilateral BPA for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Method We reviewed 210 consecutive BPA sessions for 92 CTEPH patients, including 124 unilateral BPA sessions and 86 bilateral BPA sessions. Radiation exposure, operation details, lesions characteristics and the occurrence of complications were compared between unilateral BPA and bilateral BPA. 131 BPA sessions with a hemodynamics follow-up were included for efficacy analysis, in which hemodynamics changes were compared. Logistic regression analysis was used to identify factors associated with the occurrence of complications. Result Bilateral BPA treated more lobes, arteries and lesions [3 (2, 4) vs. 2 (1, 3) lobes, p < 0.001; 8 (5.5, 10) vs. 6 (4, 8) vessels, p = 0.003; 9 (7, 12) vs. 8 (5, 10) lesions, p = 0.01] in one single session than unilateral BPA in a comparable operation duration and amount of contrast media given. Overall, the occurrence of complications was similar between bilateral BPA and unilateral BPA [9 (10.5%) vs. 12 (9.7%), p = 0.83]. Hemodynamics effects didn’t differ significantly between bilateral BPA and unilateral BPA in a single session [mPAP, − 4.5 ± 8.6 vs. − 3.6 ± 7.3 mmHg, p = 0.52; PVR, − 1.1 (− 3.5, 0.8) vs. − 1.8 (− 5.2, 0.3) Wood units, p = 0.21]. For the initial BPA session, bilateral BPA also treated more lobes, arteries and lesions than unilateral BPA [3 (2, 4) vs. 2 (1, 2) lobes, p < 0.001; 8.0 (5.8, 9.3) vs. 6.0 (4.0, 8.0) vessels, p = 0.04; 9 (6, 12) vs. 7 (4, 10) lesions, p = 0.02]. The occurrence of complications was also similar [5 (13.2%) vs. 5 (9.3%), p = 0.80], even in patients with poor baseline hemodynamics. Univariate regression analysis reveals the number of lobes treated/session, but not bilateral BPA, as predictive factors of complications. Conclusion Bilateral BPA may be safely and effectively performed in patients with CTEPH without increasing operation duration and radiation burden, even in patients with unfavorable baseline hemodynamics.

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Section: Discussionmentioning

confidence: 99%

Bilateral versus unilateral balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension

Hong

et al. 2022

Respir Res

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“…Additionally, BPA is an alternative therapy choice for inoperable patients (34,35). A systematic review confirmed that BPA or PEA can improve exercise capacity (36).…”

Section: Effect Of Exercise Training On Exercise Capacity and Qolmentioning

confidence: 90%

Effectiveness and safety of exercise training and rehabilitation in chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis

An¹,

Wang²,

Yuan³

et al. 2021

Ann Palliat Med

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Background: Patients with chronic thromboembolic pulmonary hypertension (CTEPH) still have impaired exercise training and quality of life (QoL) despite pulmonary arterial hypertension (PAH)-targeted drugs. Exercise training is considered to improve exercise capacity and QoL in patients with pulmonary hypertension (PH), but this has not been fully studied in CTEPH patients. We conducted the meta-analysis and systematic review to evaluate the effectiveness and safety of exercise training in patients with CTEPH.Methods: The relevant literature was retrieved for the meta-analysis using the PubMed, EMBASE, and Cochrane Library databases published before December 2020. The primary outcome was a change in six-minute walk distance (6MWD). We also assessed the effect of exercise training on peak oxygen uptake per kilogram (peak VO 2 /kg), mean pulmonary artery pressure (mPAP) assessed by right heart catheterization (RHC), N-terminal pro-brain-type natriuretic peptide (NT-proBNP), and QoL.Results: A total of 6 studies with 234 exercise training patients were included. In the pooled analysis, 6MWD significantly improved by 70.14 m (WMD: 58.33 to 81.95, I 2 =0) after 3-week exercise training. After 12 or 15-week exercise training, 6MWD and peak VO 2 /kg significantly improved (WMD: 106.22 m, 95% CI: 65.90 to 146.55, I 2 =87.4%, P<0.0001; 1.84 mL/min/kg, 95% CI: 0.72 to 2.96, P=0.001, respectively). Furthermore, the mPAP decreased by 12.17 mmHg after 12-week exercise training (95% CI: −14.53 to −9.82, P<0.001, I 2 =99%).The subscales of QoL such as physical function, general health perception, and mental health improved in varying degrees. NT-proBNP did not improve significantly in the pooled analysis. In addition, exercise training was well tolerated without major adverse events occurred during training, and the dropout rate was low. Discussion:Exercise training may improve exercise capacity, mPAP, and QoL, and was well tolerated among patients with CTEPH. However, more large-scale multicenter studies are needed to confirm the effectiveness and safety of exercise training in patients with CTEPH.

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“…The estimated 3-year survival is nearly 90% in CTEPH patients after PEA, compared with 70% of survival in patients without operation (4). Similarly, in a recent meta-analysis study, CTEPH patients were found to have a 97% 3-year survival rate after BPA (5). These encouraging results suggest that PEA and BPA are clearly effective as remedies for the vascular lesions and their fatal consequences in CTEPH.…”

Section: Introductionmentioning

confidence: 89%

Different response of the oxygen pathway in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy versus balloon pulmonary angioplasty

Tao

Xie

et al. 2022

Front. Cardiovasc. Med.

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BackgroundOxygen pathway limitation exists in chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) are two effective interventions for CTEPH, but their effects and comparison of these two interventions on the oxygen pathway are not well demonstrated.MethodsCTEPH patients with available pulmonary function test, hemodynamics, and blood gas analysis before and after the interventions were included for comparison of oxygen pathway in terms of lung ventilation, lung gas exchange, oxygen delivery, and oxygen extraction between these two interventions.ResultsThe change in the percentage of the predicted forced expiratory volume in the 1 s (−3.4 ± 12.7 vs. 3.8 ± 8.7%, P = 0.006) and forced vital capacity (−5.5 ± 13.0 vs. 4.2 ± 9.9%, P = 0.001) among the PEA group (n = 24) and BPA group (n = 46) were significantly different. Patients in the PEA group had a significant increase in their arterial oxygen saturation (from 92.5 ± 3.6 to 94.6 ± 2.4%, P = 0.022), while those in the BPA group had no change, which could be explained by a significant improvement in ventilation/perfusion (−0.48 ± 0.53 vs. −0.17 ± 0.41, P = 0.016). Compared with patients post-BPA, patients post-PEA were characterized by higher oxygen delivery (756.3 ± 229.1 vs. 628.8 ± 188.5 ml/min, P = 0.016) and higher oxygen extraction (203.3 ± 64.8 vs. 151.2 ± 31.9 ml/min, P = 0.001).ConclusionPartial amelioration of the oxygen pathway limitations could be achieved in CTEPH patients treated with PEA and BPA. CTEPH patients post-PEA had better performance in lung gas exchange, oxygen delivery, and extraction, while those post-BPA had better lung ventilation. Cardiopulmonary rehabilitation may assist in improving the impairment of the oxygen pathway.

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Balloon pulmonary angioplasty vs. pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis

Cited by 18 publications

References 77 publications

Bilateral versus unilateral balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension

Bilateral versus unilateral balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension

Effectiveness and safety of exercise training and rehabilitation in chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis

Different response of the oxygen pathway in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy versus balloon pulmonary angioplasty

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