Highlights
- •Adding BPA as an option at an existing CTEPH surgical center can be effective.
- •Pulmonary vascular compliance improves with BPA.
- •Chronic total occlusions can be included in a routine revascularization approach.
- •Additional research is needed to inform patient selection and surrogate outcomes.
Abstract
Introduction
Balloon pulmonary angioplasty (BPA) is a less invasive treatment alternative for patients
with chronic thromboembolic pulmonary hypertension (CTEPH) who are unable to move
forward with pulmonary thromboendarterectomy. This report describes a single-center
experience with a nascent BPA program in the United States (US).
Methods
All patients who underwent BPA between August 2018–2021 were included in this retrospective,
single-center observational cohort. Pre- and post-procedure clinical information was
collected, along with procedural characteristics.
Results
Thirty patients began their BPA series during the study period. The majority of patients
had segmental disease (n = 25, 83.3%). A total of 135 BPA procedures were performed
on 417 segments. On average, patients completed 4.5 sessions and the majority of patients
(n = 23, 76.7%) underwent more than 2. There were 24 episodes of hemoptysis and 20
procedural events that required treatment, typically with either heparin reversal
or balloon tamponade. Of 26 participants with completed series, mean PA pressure (−6 mmHg,
95% CI -9 to -4 mmHg, p = 0.0001), PVR (−1.9 Wood units, 95% CI –2.9 to −1.0, p = 0.0002),
and pulmonary compliance (−1.0 mL/mmHg, 95% CI -1.5 to −0.5, p = 0.0002) improved.
Improvement was also seen in NYHA functional classification and walk distance (p = 0.01).
Two deaths occurred, with one death peri-procedurally.
Conclusion
This paper describes an early experience with BPA at a single US center. Improvement
in non-invasive and invasive metrics were seen without adding a significant morbidity
to an already high-risk patient population.
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References
- Chronic thromboembolic pulmonary hypertension.Eur. Respir. J. 2019; 53 (Published 2019 Jan 24)1801915https://doi.org/10.1183/13993003.01915-2018
- Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension.Circulation. 2001; 103: 10-13https://doi.org/10.1161/01.cir.103.1.10
- Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension.Circ Cardiovasc Interv. 2012; 5: 748-755https://doi.org/10.1161/CIRCINTERVENTIONS.112.971077
- Percutaneous transluminal pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension.Circ Cardiovasc Interv. 2012; 5: 756-762https://doi.org/10.1161/CIRCINTERVENTIONS.112.971390
- Balloon pulmonary angioplasty: an additional treatment option to improve the prognosis of patients with chronic thromboembolic pulmonary hypertension.EuroIntervention. 2014; 10: 518-525https://doi.org/10.4244/EIJV10I4A89
- A new era of therapeutic strategies for chronic thromboembolic pulmonary hypertension by two different interventional therapies; pulmonary endarterectomy and percutaneous transluminal pulmonary angioplasty.PLoS One. 2014; 9 (Published 2014 Apr 11)e94587https://doi.org/10.1371/journal.pone.0094587
- Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: results of a multicenter registry.Circ Cardiovasc Qual Outcomes. 2017; 10e004029https://doi.org/10.1161/CIRCOUTCOMES.117.004029
- Comprehensive evaluation of the effectiveness and safety of balloon pulmonary angioplasty for inoperable chronic thrombo-embolic pulmonary hypertension: long-term effects and procedure-related complications.Eur. Heart J. 2017; 38: 3152-3159https://doi.org/10.1093/eurheartj/ehx530
- Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.Postepy Kardiol. Interwencyjnej. 2015; 11: 1-4https://doi.org/10.5114/pwki.2015.49176
- Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension. Observational study in a referral unit.Rev. Esp. Cardiol. 2019; 72: 224-232https://doi.org/10.1016/j.rec.2018.02.020
- Impact of the initiation of balloon pulmonary angioplasty program on referral of patients with chronic thromboembolic pulmonary hypertension to surgery.J. Heart Lung Transplant. 2018; 37: 1102-1110https://doi.org/10.1016/j.healun.2018.05.004
- French experience of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.Eur. Respir. J. 2019; 53 (Published 2019 May 18)1802095https://doi.org/10.1183/13993003.02095-2018
- Safety and efficacy of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension in The Netherlands.Neth. Heart J. 2020; 28: 81-88https://doi.org/10.1007/s12471-019-01352-6
- Experience of three years of balloon pulmonary angioplasty in a single centre: safety and short term results.Eur. Heart J. 2019; 40https://doi.org/10.1093/eurheartj/ehz745.1058
- Balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: first experience at the Israeli national CTEPH referral center.Isr. Med. Assoc. J. 2020; 22: 752-756
- Balloon pulmonary angioplasty vs. pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis.Heart Fail. Rev. 2021; 26: 897-917https://doi.org/10.1007/s10741-020-10070-w
- The role of balloon pulmonary angioplasty and pulmonary endarterectomy: is chronic thromboembolic pulmonary hypertension still a life-threatening disease?.Int. J. Cardiol. 2021; 326: 170-177https://doi.org/10.1016/j.ijcard.2020.10.026
- Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: initial single-center experience.Mayo Clin Proc Innov Qual Outcomes. 2019; 3 (Published 2019 Aug 23): 311-318https://doi.org/10.1016/j.mayocpiqo.2019.06.006
- Advances in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.Pulm. Circ. April 2021; https://doi.org/10.1177/20458940211007385
- Increased pulmonary arterial compliance after balloon pulmonary angioplasty predicts exercise tolerance improvement in inoperable CTEPH patients with lower pulmonary arterial pressure.Heart Lung. 2022; 52: 8-15https://doi.org/10.1016/j.hrtlng.2021.11.003
- Change in pulmonary arterial compliance and pulmonary pulsatile stress after balloon pulmonary angioplasty.Anatol. J. Cardiol. 2022; 26: 43-48https://doi.org/10.5152/AnatolJCardiol.2021.149
- Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology.J. Am. Coll. Cardiol. 2013; 62: D22-D33https://doi.org/10.1016/j.jacc.2013.10.027
- Proximal pulmonary arterial obstruction decreases the time constant of the pulmonary circulation and increases right ventricular afterload.J. Appl. Physiol. 2013; 114: 1586-1592https://doi.org/10.1152/japplphysiol.00033.2013
- Decreased time constant of the pulmonary circulation in chronic thromboembolic pulmonary hypertension.Am. J. Physiol. Heart Circ. Physiol. 2013; 305: H259-H264https://doi.org/10.1152/ajpheart.00128.2013
Article info
Publication history
Published online: March 17, 2023
Accepted:
March 13,
2023
Received in revised form:
March 10,
2023
Received:
September 21,
2022
Identification
Copyright
© 2023 Published by Elsevier Ltd.
