Predictors of residual pulmonary hypertension after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

Tsuji, Akiko; Ogo, Takeshi; Ueda, Jin; Fukui, Shigefumi; Morita, Yoshiaki; Fukuda, Tsuyoshi; Nakanishi, Norifumi; Ogawa, Hisao; Yasuda, Satoshi

doi:10.1016/j.ijcard.2016.09.132

Cited by 17 publications

(22 citation statements)

References 10 publications

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“…Most studies of BPA to date have been conducted in patients with a baseline mPAP >30 mmHg, and predictors of treatment success have been identified as duration from symptom onset, baseline diastolic PAP and diastolic pressure gradient [33]. Several Japanese centres have described improvements in haemodynamics, symptoms and exercise capacity after BPA, with generally low rates of major complications and post-procedural mortality [19,21,22,26,27,29,30,32], with some follow-up over a year [21,22,30].…”

Section: History Evolution and Evidence For Bpamentioning

confidence: 99%

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

et al. 2017

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Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA) is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH.

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Section: History Evolution and Evidence For Bpamentioning

confidence: 99%

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

et al. 2017

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“…In a recent study, up to 23% of patients had persistent PH [58]. Persistent PH does not appear to affect 1-year survival; however, it is associated with significant impairment in functional capacity and increased symptom severity compared with that reported in patients without persistent PH [58].…”

Section: Balloon Pulmonary Angioplastymentioning

confidence: 91%

“…Despite the benefits associated with BPA, not all patients respond satisfactorily to the procedure [58]. In a recent study, up to 23% of patients had persistent PH [58].…”

Section: Balloon Pulmonary Angioplastymentioning

confidence: 99%

“…Outcomes after BPA BPA has been shown to improve symptoms, function and haemodynamic parameters in patients [21,22,[56][57][58][59][60]. Results from one experienced centre have shown an average reduction in PVR of 57% [22], as well as improvements in functional class, exercise capacity and brain natriuretic peptide levels, at 3 months post-BPA [21,22].…”

Section: Balloon Pulmonary Angioplastymentioning

confidence: 99%

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The changing landscape of chronic thromboembolic pulmonary hypertension management

2017

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For patients with chronic thromboembolic pulmonary hypertension (CTEPH), the current standard of care involves surgical removal of fibro-thrombotic obstructions by pulmonary endarterectomy. While this approach has excellent outcomes, significant proportions of patients are not eligible for surgery or suffer from persistent/recurrent pulmonary hypertension after the procedure. The availability of balloon pulmonary angioplasty and the approval of the first medical therapy for use in CTEPH have significantly improved the outlook for patients ineligible for pulmonary endarterectomy. In this comprehensive review, we discuss the latest developments in the rapidly evolving field of CTEPH. These include improvements in imaging modalities and advances in surgical and interventional techniques, which have broadened the range of patients who may benefit from such procedures. The efficacy and safety of targeted medical therapies in CTEPH patients are also discussed, particularly the encouraging data from the recent MERIT-1 trial, which demonstrated the beneficial impact of using macitentan to treat patients with inoperable CTEPH, including those on background therapy. As the treatment options for CTEPH improve, hybrid management involving more than one intervention in the same patient may become a viable option in the near future.

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“…There is no consensus regarding the definition of BPA success or failure. Tsuji et al 22 defined BPA responders as patients who achieved a mean PAP # 30 mm Hg at follow-up. However, the mean PAP value following BPA procedures cannot be used alone to identify responders and nonresponders.…”

Section: Definition Of Bpa Success and Failurementioning

confidence: 99%

Poor Subpleural Perfusion Predicts Failure After Balloon Pulmonary Angioplasty for Nonoperable Chronic Thromboembolic Pulmonary Hypertension

Taniguchi

Brénot

Jaïs

et al. 2018

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PSP in the capillary phase, suggesting the presence of small vessel disease with diffuse distal thrombosis, is a predictor of BPA failure. PSP was also associated with less developed bronchial arteries, which suggests a key role of bronchial-pulmonary anastomoses in maintaining the pulmonary capillary bed open downstream of the pulmonary arterial obstruction. PSP affected approximately 15% of patients with nonoperable CTEPH who underwent BPA.

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Predictors of residual pulmonary hypertension after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

Cited by 17 publications

References 10 publications

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

The changing landscape of chronic thromboembolic pulmonary hypertension management

Poor Subpleural Perfusion Predicts Failure After Balloon Pulmonary Angioplasty for Nonoperable Chronic Thromboembolic Pulmonary Hypertension

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