Mildly improved hemodynamics and overall low mortality rates have been reported following the use of balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). A systematic review and meta-analysis on the subject were conducted, with the results published in the International Journal of Cardiology.
A total of 17 prospective, noncomparative, observational studies that included 670 patients with CTEPH were included in the analysis. All of the studies had small sample sizes (ie, <100 patients). Studies with <20 patients were excluded from the analysis. The mean age of the participants ranged from 57.0 to 70.0 years, with a median age of 62.5 years. There were a median of 4 BPA sessions conducted per patient across the studies. Overall, the studies included a majority (68.4%) of women. Methodologic quality evaluation of the included studies suggested a high risk for bias, based mainly on the lack of a comparison group.
Five studies that included 167 patients reported the development of procedure-related complications. Of these pooled periprocedural complications, the most common was reperfusion lung injury in 25% of individuals, which was followed by reperfusion edema in 16%. In addition, the pooled incidence of perforation by guidewire, right ventricular failure, and acute pulmonary embolism was 3.6%, 1.8%, and 1.2%, respectively.
The meta-analysis demonstrated significantly decreased mean pulmonary artery pressure (–14.2 mm Hg; 95% CI, –18.9 to –9.5 mm Hg), pulmonary vascular resistance (–303.5 dyn · s/cm5; 95% CI, –377.6 to –229.4 dyn · s/cm5), and mean right arterial pressure (–2.7 mm Hg; 95% CI, –4.1 to –1.3 mm Hg) following the use of BPA. Moreover, 6-minute walk distance (67.3 m; 95% CI, 53.8-80.8 m) and cardiac output (0.21/min; 95% CI, 0.0-0.3/min) were also significantly increased following BPA.
In 12 studies that reported mortality with a median follow-up of 9 months after BPA (range, 1-51 months), the pooled incidence of short-term (ie, ≤1 month) and long-term (ie, >1 month) mortality was 1.9% and 5.7%, respectively.
The investigators concluded that the noncomparative evidence derived from this analysis can be used to facilitate clinical decision making until the results of larger, international multicenter randomized controlled studies become available.
Khan MS, Amin E, Memon MM, et al. Meta-analysis of use of balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension [published online February 23, 2019]. Int J Cardiol. doi:10.1016/j.ijcard.2019.02.051