Mid‐term follow‐up of balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: An experience in Latin America

Abstract

Objectives To describe the characteristics of patients who undergo balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) and report the mid‐term outcomes. Background BPA has been recently introduced in Latin America. Mid‐term results have not been published. Methods Prospective Chilean Registry of inoperable CTEPH patients who underwent BPA. Clinical variables were analyzed at baseline, after each procedure and at follow‐up. Hemodynamic variables were recorded before and after the last BPA. Results Between August 2016 and September 2019, 22 patients (17 women), 59 ± 12.7 years, underwent 81 BPA and were followed for as long as 33.1 months (mean 17.3 ± 7.5). Mean pulmonary artery pressure decreased by 17.4% (51.1 ± 12 vs. 42.2 ± 13 mmHg, p = .001), pulmonary vascular resistance by 23.9% (766.7 ± 351 vs. 583 ± 346 dynes/s/cm−5, p = .001), cardiac index increased by 8% (2.3 ± 0.54 vs. 2.5 ± 0.54 L/min/m2, p = .012), N‐terminal pro‐B‐type natriuretic peptide decreased by 73.8% (1,685 ± 1,045 vs. 441.8 ± 276 pg/dl, p = .006), and 6‐min walk distance improved by 135 m (316.7 ± 94 vs. 451.1 ± 113 m, p = .001). One patient (4.5%) developed lung reperfusion injury and four patients (18.2%) had minor bleeding (hemoptysis), after the procedure. There was no mortality associated with BPA. Conclusions Our results confirm that BPA for inoperable CTEPH is a relatively safe procedure that improves clinical and hemodynamic parameters in the mid‐term. This therapy should be considered as an alternative, mainly in places where access to PAH therapy or surgery is restricted.

Refined balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension – reference center experience

“…The number of periprocedural complications in the study group does not differ from those found in European and American reports [10,13,14,[18][19][20][21][22], with the procedure methodology and many years of experience documented in Japanese publications significantly contributing to reducing the number of deaths [5,16,17,23]. The available publications present various approaches to using additional endovascular techniques for BPA, but in the studied single-center group, this translated into treatment effectiveness and safety [11][12][13][14][15][16][17].…”

“…The essence of this procedure is the percutaneous insertion of a balloon catheter into the pulmonary artery and inflation of the fibrotic remnant of the thrombus, which improves perfusion, reduces vascular resistance and pressure in the vessel, and improves the prognosis. After the first reports from 1988 and initial unsatisfactory results, the method has been improved in recent decades and has consolidated its position in treating CTEPH patients [1][2][3][4][5][6][7][8][9][10][11].…”

Imaging characteristics relevant to pulmonary perfusion improvement after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

“…With the progress of technology and the accumulation of clinical experience, BPA can effectively improve hemodynamics, cardiac function, and symptoms without severe complications [4][5][6][7][8][9]. Nowadays, it has been an effective alternative therapy for patients who cannot undergo PEA or with residual or recurrent pulmonary hypertension after PEA [10,11].…”

Assessment of Clinical Usefulness of Resting Electrocardiogram (PH-ECG Score) in Monitoring the Efficacy of Balloon Pulmonary Angioplasty (BPA) in Patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

“…Such patients may be subjected to a series of balloon pulmonary angioplasty (BPA) procedures [ 6 , 7 , 8 , 9 , 10 ]. An assessment of the effects of subsequent BPA sessions, as well as long-term follow-up of patients after the completed therapy, requires, for example, invasive examination, such as right heart catheterization (RHC) [ 11 ]. The main purpose of this study is to create a simple electrocardiographic (ECG) scale, useful in clinical practice, which could be used to monitor the efficacy of interventional therapies, such as BPA, in patients with CTEPH.…”