Safety and efficacy of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension in the Netherlands

Abstract

Background Balloon pulmonary angioplasty (BPA) is an emerging treatment in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic disease (CTED). We describe the first safety and efficacy results of BPA in the Netherlands. Methods We selected all consecutive patients with inoperable CTEPH and CTED accepted for BPA treatment who had a six-month follow-up in the St. Antonius Hospital in Nieuwegein and the Amsterdam University Medical Center (UMC) in Amsterdam. Functional class (FC), N‑terminal pro-brain natriuretic peptide (NT-proBNP), 6‑minute walking test distance (6MWD) and right-sided heart catheterisation were performed at baseline and six months after last BPA. Complications for each BPA procedure were noted. Results A hundred and seventy-two BPA procedures were performed in 38 patients (61% female, mean age 65 ± 15 years). Significant improvements six months after BPA treatment were observed for functional class (63% FC I/II to 90% FC I/II, p = 0.014), mean pulmonary artery pressure (−8.9 mm Hg, p = 0.0001), pulmonary vascular resistance (−2.8 Woods Units (WU), p = 0.0001), right atrial pressure (−2.0 mm Hg, p = 0.006), stroke volume index (+5.7 ml/m2, p = 0.009) and 6MWD (+48m, p = 0.007). Non-severe complications occurred in 20 (12%) procedures. Conclusions BPA performed in a CTEPH expert centre is an effective and safe treatment in patients with inoperable CTEPH.

Balloon Pulmonary Angioplasty: State of the Art

“…Table 1 outlines the registries published to date (excluding, where possible, those covering the same population more than once). [ 22 – 36 ]…”

Efficacy and safety of riociguat in the treatment of chronic thromboembolic pulmonary arterial hypertension

“…[ 6 ] Recent study found that BPA could significantly improve pulmonary hemodynamics and exercise capacity of patients with inoperable CTEPH, and better safety was guaranteed. [ 7 ] Furthermore, a systematic review assessed the efficacy and safety of BPA for CTEPH, and the results showed that BPA could improve hemodynamics and increase survival rate. [ 8 ] On the other hand, such targeted therapies as soluble guanylate cyclase stimulators (riociguat), PDE-5 inhibitors (sildenafil), endothelin receptor antagonists (bosentan and macitentan) and prostacyclin analogues (iloprost, beraprost, and treprostinil) had shown better effects in patients with CTEPH.…”

Balloon pulmonary angioplasty in the treatment of chronic thromboembolic pulmonary hypertension: recent advances and future perspectives

“…32,33 Meanwhile, various centers around the world have published their initial results. [34][35][36][37][38][39] In TABle 1, we summarized initial experiences beginning with the United States group in 2001, then presenting the Japanese registry (7 centers) and the first European groups. It becomes obvious that especially the hemodynamic improvement is usually less pronounced than in Japanese studies.…”

“…Further, balloon size is slightly underestimated to avoid pulmonary artery rupture. The intervention is performed under fluoroscopy guidance, and numerous centers use digital subtraction angiography to document the postinterventional result [29][30][31][32][33][34][35][36][37][38][39][40] (FiGuRe 1). Meanwhile, various refinements have been suggested such as the use of optical coherence tomography, 48 dyna-computed tomography, 49 as well as pressure wires and intravascular ultrasound.…”

“…For the evaluation of mid -term outcomes at 6 to 12 months after BPA, physical capacity (World Health Organization functional class, 6-minute walking distance), evaluation of quality of life, echocardiography, cardiopulmonary exercise test, oxygenation level, and pulmonary hemodynamics are usually used. [29][30][31][32][33][34][35][36][37][38][39][40]54 Additionally, blood serum biomarkers such as N -terminal fragment of the prohormone brain natriuretic peptide, 55 high -sensitivity cardiac troponin T, 56 growth differentiation factor 15, soluble suppression of tumorigenesis 2, 57 pregnancy -associated plasma protein A, 58 cartilage intermediate layer protein 1, 59 as well as cardiac magnetic resonance imaging 60 and electrocardiography 61 may be useful noninvasive diagnostic tools. The invasive measurement of pulmonary hemodynamics, not only at rest but also during exercise, offers a differentiated insight into the hemodynamic changes after BPA.…”