Refined Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension

Bashir, Riyaz; Noory, Ali J.; Oliveros, Estefanía; Romero, Carlos Manuel; Maruthi, Rohit; Mirza, Arslan; Lakhter, Vladimir; Zhao, Huaqing; Brisco‐Bacik, Meredith A.; Vaidya, Anjali; Auger, William R.; Forfia, Paul R.

doi:10.1016/j.jacadv.2023.100291

Cited by 5 publications

(7 citation statements)

References 32 publications

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“…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].…”

Section: Discussionmentioning

confidence: 70%

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

Łabyk,

Krakowian,

Mysiorski

et al. 2024

pwki

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Introduction Chronic thromboembolic pulmonary hypertension (CTEPH), characterized by thromboembolic changes affecting the pulmonary bed, leads to ventricular function deterioration and premature death. The introduction of balloon pulmonary angioplasty (BPA) has significantly improved the prognosis of CTEPH patients. Aim The authors of this article decided to summarize the experience of the BPA program, conducted between 2014 and 2022, at the reference center. Material and methods Among 111 CTEPH patients, 55 were included in the analysis. A total of 226 sessions were performed, with a significant percentage of intravascular imaging and pressure catheter use. Results Mean pulmonary pressure decreased significantly from 42 (22–66) to 26.5 mm Hg (11–54) ( p < 0.05). Pulmonary vascular resistance and natriuretic peptide concentration decreased from 6.67 (1.66–14) to 3.295 Wood units (1.09–11.11), respectively, and from 1934 (60–16963) to 296 (21–9901) ng/ml ( p < 0.05). There was also an improvement in the functional class (WHO) from 2.85 ±0.61 to 2.15 ±0.62 and an increase in the 6-minute walking distance from 300 ±131 to 367 ±154 m ( p < 0.05). There were no in-hospital deaths or within 30 days of the procedure. Arterial damage occurred during nine sessions ( n = 9/226, 4%), while 0.9% ( n = 2/226) were complicated by acute right ventricular failure. Post-reperfusion pulmonary edema (RPE 0 – none) was observed in almost 90% of the sessions, grade 1 to 3 RPE occurred in 10.2%, and grade 4 RPE was not noted. Conclusions BPA programs conducted in experienced centers are a safe and effective treatment option for inoperable CTEPH patients.

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Section: Discussionmentioning

confidence: 70%

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

Łabyk,

Krakowian,

Mysiorski

et al. 2024

pwki

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“…In a recent publication evaluating the efficacy and safety of BPA, an analysis of BPA treatment outcomes in two collaborating CTEPH referral centers in Poland, characterized by similar geographical and baseline clinical characteristics to Latvian CTEPH patients, showed improvement in mean 6MWD of 68 m and change in WHO FC from (I-II 20%/III-IV 80%) to (I-II 77%/III-IV 23%) [39]. Other studies show improvements of 6MWD on average of 30-70 m, and a WHO functional class increase in most patients [22,27,[40][41][42][43]. Our results show an improvement in WHO functional class and a significant 6MWD improvement after the first BPA session; these results are promising, particularly because both attributes contribute to increasing quality of life.…”

Section: Discussionmentioning

confidence: 80%

“…As with our results, we observed a reduction in BNP levels of 103 pg/mL (35.6% from baseline), demonstrating a reduction in right ventricular wall stress after BPA. Other centers have shown improvements in mean NT-pro-BNP from 220 to 1101 pg/mL [2,39,42] and mean BNP from 60.8 to 196.2 pg/mL after the BPA procedures [27,40,43].…”

Section: Discussionmentioning

confidence: 98%

The Initial Experience of Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension in Latvia

Krigere,

Kalejs,

Kaulins

et al. 2024

Medicina

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Background: Treatment options for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or persistent pulmonary hypertension after pulmonary endarterectomy (PEA) include targeted medical therapy and balloon pulmonary angioplasty (BPA). BPA is an emerging treatment modality that has been reported to improve functional capacity, pulmonary hemodynamics, and right ventricular function. Reports from expert centers are promising, but more data are needed to make the results more generalizable. Materials and Methods: We conducted a prospective analysis of nine consecutive CTEPH patients who underwent balloon pulmonary angioplasty (BPA) sessions at Pauls Stradins Clinical University Hospital in Riga, Latvia between 1 April 2022 and 1 July 2023. We assessed World Health Organization (WHO) functional class, 6 min walk distance (6MWD), blood oxygen saturation (SpO2), brain natriuretic peptide (BNP) level at baseline and 3 months after the first BPA session. For two patients on whom repeated BPA sessions were performed, we additionally assessed cardiac output (CO), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (mPAP). Results: A total of 12 BPA procedures for nine patients were performed; repeated BPA sessions were performed for two patients. Our results show a reduction in BNP levels and improvement in WHO functional class, 6MWD, and SpO2 after the first BPA session. Improvement in 6MWD was statistically significant. Additionally, an improvement in pulmonary hemodynamic parameters was observed. Conclusions: Our data show that BPA is an effective interventional treatment modality, improving both the pulmonary hemodynamics and functional status. Moreover, BPA is safe and excellently tolerated.

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“…In this issue of JACC: Advances , Bashir et al 2 describe methods and outcome in a cohort of 77 patients undergoing balloon pulmonary angioplasty at a single center in the United States. The findings confirm reasonable safety; only 3 patients experienced major procedure-related complications, including one death, and hemoptysis occurred in only 4.7% of procedures.…”

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confidence: 99%

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Frantz

2023

JACC: Advances

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Refined Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension

Cited by 5 publications

References 32 publications

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

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

The Initial Experience of Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension in Latvia

Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

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