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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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 Elsevier Ltd. All rights reserved.
