Background
Although pulmonary endarterectomy is the treatment of choice for chronic thromboembolic
pulmonary hypertension, not all patients are eligible. While balloon pulmonary angioplasty
is an alternative for such patients, its efficacy and safety may differ between patients
with and without surgically accessible lesions.
Methods
This study involved 344 patients treated with balloon pulmonary angioplasty who were
ineligible for pulmonary endarterectomy. Based on the angiographical lesion location,
patients were divided into the surgically accessible (Group 1) and inaccessible (Group
2) groups, and percent changes in hemodynamics and clinical parameters before and
after balloon pulmonary angioplasty were investigated. We also conducted survival
analyses using Kaplan–Meier analysis.
Results
While no differences in baseline characteristics were identified between the groups,
balloon pulmonary angioplasty significantly improved hemodynamics in both groups,
without any difference regarding the incidence of complications. Meanwhile, the percent
changes in the mean pulmonary arterial pressure, pulmonary vascular resistance, 6-min
walk distance, right ventricular area index on echocardiography, and the achievement
rate of World Health Organization functional class I after balloon pulmonary angioplasty
were significantly lower in Group 1 than in Group 2. The cumulative survival rates
at 1, 5, and 10 years after balloon pulmonary angioplasty were not significantly different
between the two groups (Group 1: 92.5%, 86.1%, 84.3%; and Group 2: 96.5%, 92.9%, 90.1%,
respectively).
Conclusions
The outcome of balloon pulmonary angioplasty in inoperable patients with surgically
accessible proximal lesions was acceptable; however, further investigations are necessary
to clarify the optimal treatment for such patients.
KEYWORDS
Abbreviations:
PEA (pulmonary endarterectomy), CTEPH (chronic thromboembolic pulmonary hypertension), BPA (balloon pulmonary angioplasty), WHO-Fc (World Health Organization functional class), SpO2 (percutaneous oxygen saturation), 6MWD (6-min walk distance), BNP (brain natriuretic peptide), RVAI (right ventricular area index), mPAP (mean pulmonary arterial pressure), PVR (pulmonary vascular resistance), RHC (right heart catheterization)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 18, 2023
Publication stage
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© 2023 International Society for Heart and Lung Transplantation. All rights reserved.
