Improved Hemodynamics in CTEPH With Balloon Pulmonary Angioplasty

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Balloon pulmonary angioplasty may be an important therapeutic option in patients with chronic thromboembolic pulmonary hypertension.
Balloon pulmonary angioplasty may be an important therapeutic option in patients with chronic thromboembolic pulmonary hypertension.

Hemodynamics may improve in patients with chronic thromboembolic pulmonary hypertension (CTEPH) after balloon pulmonary angioplasty (BPA), with complication rates comparable to those of pulmonary endarterectomy, according to a study published in Circulation Cardiovascular Quality and Outcomes

Researchers performed a retrospective review of clinical outcomes and complications in 1408 procedures in 308 patients at 7 institutions in Japan to determine the safety and efficacy of BPA as a treatment modality for patients with CTEPH. The primary end point of the study was all-cause death. Long-term survival from the initial BPA and the final BPA procedures was examined.

After the final BPA, mean pulmonary arterial pressure was reduced from 43.2±11.0 to 24.3±6.4 mm Hg and at follow-up, was further reduced to 22.5±5.4 mm Hg as well as reduction in the use of oxygen supplementation.

The most common complications observed were pulmonary injury (17.8%) and hemoptysis (14.0%), with a total complication rate of 36.3% (511 out of 1154 procedures). The leading causes of death were right heart failure, multiorgan failure, and sepsis. Overall survival rate at 1 to 2 years was 96.8% (95% CI, 93.7%-98.4%) and at 3 years was 94.5% (95% CI, 89.3%-97.3%) after the initial BPA procedure was performed in 308 patients.

Data from only 1 country and 1 racial population were identified as limitations of this study.

Investigators concluded that while the complication rate was high in patients treated with BPA, it was comparable to the rate in those who had undergone pulmonary endarterectomy. 

Overall, hemodynamics improved significantly after treatment with BPA, suggesting that clinicians should consider BPA as “an important therapeutic option in patients with [CTEPH].”

Reference

Ogawa A, Satoh T, Fukuda T, et al. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: results of a multicenter registry [published online on November 10, 2017]. Circ Cardiovasc Qual Outcomes. doi:10.1161/CIRCOUTCOMES.117.004029

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