Balloon pulmonary angioplasty vs riociguat in patients with inoperable chronic thromboembolic pulmonary hypertension: A systematic review and meta‐analysis

Wang, Wuwan; Li, Wen; Song, Zigen; Shi, Wenhai; Wang, Ke; Huang, Wei

doi:10.1002/clc.23212

Cited by 24 publications

(10 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…BPA is a recently established method in patients with inoperable CTEPH (4). It is associated with moderate improvements in pulmonary vascular hemodynamics with an average 20%-30% decrease in mPAP and PVR and a similar amount of increase in cardiac index (4)(5)(6)(7)(8)(9). Successful BPA can increase exercise capacity and quality of life and also decrease the requirement for supplemental oxygen therapy and the need for costly PAH-specific drug therapies (6,9).…”

Section: Discussionmentioning

confidence: 99%

“…Balloon pulmonary angioplasty (BPA) is a recently established method used in patients with inoperable or residual CTEPH (3). It has been shown to decrease mean pulmonary artery pressure (mPAP) and PVR and improve functional capacity, quality of life, and response to PH-specific therapy (4)(5)(6)(7)(8)(9). Although the main mechanism of BPA is to eliminate proximal occlusive lesions and to reduce proximal PVR, it may also be beneficial in reducing C PA and pulsatile stress by decompressing the pressure-loaded pulmonary arteries.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Change in pulmonary arterial compliance and pulmonary pulsatile stress after balloon pulmonary angioplasty

Akaslan¹,

Atas²,

Aslanger³

et al. 2022

The Anatolian Journal of Cardiology

View full text Add to dashboard Cite

Objective: Although the underlying pathology of chronic thromboembolic pulmonary hypertension (CTEPH) is mechanical obliteration of the major pulmonary vessels, high pulsatile stress penetrating into the normal distal pulmonary microvasculature resulting from reduced pulmonary arterial compliance (C PA ) may cause progressive deterioration in pulmonary hemodynamics. Hypothetically, balloon pulmonary angioplasty (BPA) may be beneficial in reducing C PA and pulsatile stress in patients with CTEPH. Methods: In total, 26 patients with available pre-and post-BPA right heart catheterization results were included in the study. BPA was performed in a series of staged procedures by 2 experienced interventional cardiologists. Results: The median C PA showed a 59.2% increase (1.03 to 1.64 mL/mm Hg, p=0.005). The median pre-BPA pulsatile stress product decreased by 20.7% (4,266 to 3,380 mm Hg/min, p=0.003). A linear regression model established that the percent change in C PA after BPA accounted for 21.8% of the explained variability in the change in 6-minute walk test (p=0.009). Conclusion:Our results indicate that BPA decreases C PA and pulmonary pulsatile stress. These changes may be partly responsible for the improvement in functional capacity after BPA.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Change in pulmonary arterial compliance and pulmonary pulsatile stress after balloon pulmonary angioplasty

Akaslan¹,

Atas²,

Aslanger³

et al. 2022

The Anatolian Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…However, Phan et al 's investigation did not include several key studies pertaining to BPA 8,[22][23][24][25][26][27][28][29] and pulmonary vasodilators 12,33,34,39,43,46 . Wang et al also compared riociguat to BPA in patients with inoperable CTEPH 58 . The results in this investigation matched those in our overall investigation and our sensitivity analysis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Balloon Pulmonary Angioplasty and Pulmonary Vasodilators for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Kalra

Duval

Thenappan

et al. 2020

Sci Rep

View full text Add to dashboard Cite

treatment options for chronic thromboembolic pulmonary hypertension (ctepH) that is not amenable to thromboendarterectomy or is recurrent/persistent after thromboendarterectomy (inoperable CTEPH) include pulmonary vasodilators or balloon pulmonary angioplasty (BPA). We compared efficacy and safety outcomes of BpA with or without pulmonary vasodilators to pulmonary vasodilator therapy alone in patients with inoperable ctepH. observational and randomized trial data reporting outcomes for >5 patients with inoperable CTEPH were sought. Single-arm random effects meta-analyses were performed. The primary outcome was change in six-minute walk distance (6MWD). Secondary outcomes included safety; World Health organization functional class (WHo fc); and change in mean pulmonary arterial pressure (mpAp), pulmonary vascular resistance (pVR), and cardiac index. thirtyfour studies with 1604 patients were eligible for analyses. Both treatments resulted in significant improvement in 6MWD (71.0 meters, 95% CI: 47.4-94.5 meters with BPA versus 47.8 meters, 95% CI: 34.5-61.2 meters with pulmonary vasodilators), PVR [−3.1 Wood Units (WU), 95% CI: −4.9 to −1.4 WU versus −1.6 WU, 95% CI: −2.4 to −0.8 WU] and mPAP (−14.8 mmHg, 95% CI: −18.2 to −11.5 mmHg versus −4.9 mmHg, 95% CI: −6.9 to −2.8 mmHg). Cardiac index was similar and most patients were WHo fc ii and iii after their respective interventions. More complications occurred in the BpA arm. In conclusion, BPA and pulmonary vasodilators both improve 6MWD and hemodynamics in patients with inoperable CTEPH. While BPA may offer greater functional and hemodynamic improvements, this technique carries the accompanying risks of an invasive procedure. Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by macrovascular obstruction due to thromboemboli with an accompanying small vessel pulmonary arteriopathy 1. Pulmonary thromboendarterectomy is the gold standard treatment for CTEPH with numerous centers of excellence worldwide 2,3. However, over 40% of CTEPH patients are ineligible for pulmonary thromboendarterectomy, due to a combination of technical inaccessibility of thromboemboli, poor surgical candidacy, patient choice, or recurrent/persistent pulmonary hypertension after the operation 4,5. CTEPH patients who are not amenable to thromboendarterectomy, develop CTEPH recurrence after thromboendarterectomy, or have persistent CTEPH despite thromboendarterectomy (inoperable CTEPH) have worse outcomes than patients who successfully undergo operative intervention 6,7. In view of this, new treatments have emerged for this patient population. Balloon pulmonary angioplasty (BPA) is a percutaneous approach that employs sequential pulmonary artery angioplasty to relieve the macrovascular obstruction associated with CTEPH 6. This approach improves exercise capacity and hemodynamics 8. Furthermore, pulmonary vasodilators

show abstract

“…A supportive evidence base is emerging for efficacy, including a meta-analysis suggesting superiority of BPA when compared to riociguat. [ 48 ] The recently completed randomised controlled Riociguat Versus Balloon Pulmonary Angioplasty in Non-operable Chronic Thrombombolic Pulmonary Hypertension (RACE) trial (ERS 2019 abstract), included 124 patients randomised 1:1 to either BPA or riociguat. After 6 months PVR fell by 60% in the BPA group and 32% in the medical therapy group (p<0.001).…”

Section: Balloon Pulmonary Angioplastymentioning

confidence: 99%

Balloon Pulmonary Angioplasty: State of the Art

2021

View full text Add to dashboard Cite

Balloon pulmonary angioplasty (BPA) is a novel technique for the treatment of chronic thromboembolic pulmonary hypertension. While cardiologists need no introduction to the concept of balloon angioplasty, BPA has its own particular challenges. This article aims to provide the reader with an overview of BPA, starting with an introduction to chronic thromboembolic disease (CTED), the standard management of chronic thromboembolic pulmonary hypertension (CTEPH), technical challenges faced when performing BPA and the evidence base supporting its use. The second part of the article will focus on the future of BPA, in particular the areas where research is required to establish an evidence base to justify the role of BPA in CTEPH and CTED treatment.

show abstract

Balloon pulmonary angioplasty vs riociguat in patients with inoperable chronic thromboembolic pulmonary hypertension: A systematic review and meta‐analysis

Cited by 24 publications

References 43 publications

Change in pulmonary arterial compliance and pulmonary pulsatile stress after balloon pulmonary angioplasty

Change in pulmonary arterial compliance and pulmonary pulsatile stress after balloon pulmonary angioplasty

Comparison of Balloon Pulmonary Angioplasty and Pulmonary Vasodilators for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Balloon Pulmonary Angioplasty: State of the Art

Contact Info

Product

Resources

About