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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Comparison of the safety and efficacy of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension patients with surgically accessible and inaccessible lesions

Published:January 18, 2023DOI:https://doi.org/10.1016/j.healun.2023.01.003

      Abstract

      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.

      List of non-standard 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 walking distance), BNP (brain natriuretic peptide), RVAI (right ventricular area index), mPAP (mean pulmonary artery pressure), PVR (pulmonary vascular resistance), RHC (right heart catheterization)
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      References

        • Kim NH
        • Delcroix M
        • Jais X
        • et al.
        Chronic thromboembolic pulmonary hypertension.
        Eur Respir J. 2019; 53
        • Humbert M
        • Kovacs G
        • Hoeper MM
        • et al.
        2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.
        Eur Heart J. 2022;
        • Cannon JE
        • Su L
        • Kiely DG
        • et al.
        Dynamic Risk Stratification of Patient Long-Term Outcome After Pulmonary Endarterectomy: Results From the United Kingdom National Cohort.
        Circulation. 2016; 133: 1761-1771
        • Delcroix M
        • Lang I
        • Pepke-Zaba J
        • et al.
        Long-Term Outcome of Patients With Chronic Thromboembolic Pulmonary Hypertension: Results From an International Prospective Registry.
        Circulation. 2016; 133: 859-871
        • Madani M
        • Mayer E
        • Fadel E
        • Jenkins DP.
        Pulmonary Endarterectomy. Patient Selection, Technical Challenges, and Outcomes.
        Ann Am Thorac Soc. 2016; 13: S240-S247
        • Voorburg JA
        • Cats VM
        • Buis B
        • Bruschke AV.
        Balloon angioplasty in the treatment of pulmonary hypertension caused by pulmonary embolism.
        Chest. 1988; 94: 1249-1253
        • Feinstein JA
        • Goldhaber SZ
        • Lock JE
        • Ferndandes SM
        • Landzberg MJ.
        Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension.
        Circulation. 2001; 103: 10-13
        • Mizoguchi H
        • Ogawa A
        • Munemasa M
        • Mikouchi H
        • Ito H
        • Matsubara H.
        Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension.
        Circ Cardiovasc Interv. 2012; 5: 748-755
        • Kawakami T
        • Ogawa A
        • Miyaji K
        • et al.
        Novel Angiographic Classification of Each Vascular Lesion in Chronic Thromboembolic Pulmonary Hypertension Based on Selective Angiogram and Results of Balloon Pulmonary Angioplasty.
        Circ Cardiovasc Interv. 2016; 9e003318
        • Shimokawahara H
        • Ogawa A
        • Mizoguchi H
        • Yagi H
        • Ikemiyagi H
        • Matsubara H.
        Vessel Stretching Is a Cause of Lumen Enlargement Immediately After Balloon Pulmonary Angioplasty: Intravascular Ultrasound Analysis in Patients With Chronic Thromboembolic Pulmonary Hypertension.
        Circ Cardiovasc Interv. 2018; 11e006010
        • Ejiri K
        • Ogawa A
        • Fujii S
        • Ito H
        • Matsubara H.
        Vascular Injury Is a Major Cause of Lung Injury After Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension.
        Circ Cardiovasc Interv. 2018; 11e005884
        • Shimokawahara H
        • Nagayoshi S
        • Ogawa A
        • Matsubara H.
        Continual Improvement in Pressure Gradient at the Lesion After Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension.
        Can J Cardiol. 2021; 37: 1232-1239
        • Minatsuki S
        • Kiyosue A
        • Kodera S
        • et al.
        Effectiveness of balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension despite having lesion types suitable for surgical treatment.
        J Cardiol. 2020; 75: 182-188
        • Darocha S
        • Araszkiewicz A
        • Kurzyna M
        • et al.
        Balloon Pulmonary Angioplasty in Technically Operable and Technically Inoperable Chronic Thromboembolic Pulmonary Hypertension.
        Journal of Clinical Medicine. 2021; 10: 1038
        • von Elm E
        • Altman DG
        • Egger M
        • Pocock SJ
        • Gøtzsche PC
        • Vandenbroucke JP.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.
        Int J Surg. 2014; 12: 1495-1499
        • Jenkins D
        • Madani M
        • Fadel E
        • D'Armini AM
        • Mayer E
        Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension.
        Eur Respir Rev. 2017; 26
        • Madani MM.
        Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: state-of-the-art 2020.
        Pulm Circ. 2021; 1120458940211007372
        • Pepke-Zaba J
        • Delcroix M
        • Lang I
        • et al.
        Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry.
        Circulation. 2011; 124: 1973-1981
        • Guth S
        • D'Armini AM
        • Delcroix M
        • et al.
        Current strategies for managing chronic thromboembolic pulmonary hypertension: results of the worldwide prospective CTEPH Registry.
        ERJ Open Res. 2021; 7
        • D'Armini AM
        • Morsolini M
        • Mattiucci G
        • et al.
        Pulmonary endarterectomy for distal chronic thromboembolic pulmonary hypertension.
        J Thorac Cardiovasc Surg. 2014; 148 (12.e1-2; discussion 11-2): 1005-1011
        • Jenkins D.
        Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension.
        Eur Respir Rev. 2015; 24: 263-271
        • Madani M
        • Ogo T
        • Simonneau G.
        The changing landscape of chronic thromboembolic pulmonary hypertension management.
        Eur Respir Rev. 2017; 26
        • Ogawa A
        • Satoh T
        • Fukuda T
        • et al.
        Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Results of a Multicenter Registry.
        Circ Cardiovasc Qual Outcomes. 2017; 10
        • Darocha S
        • Pietura R
        • Banaszkiewicz M
        • et al.
        Balloon Pulmonary Angioplasty with Stent Implantation as a Treatment of Proximal Chronic Thromboembolic Pulmonary Hypertension.
        Diagnostics (Basel). 2020; 10
        • Gerges C
        • Friewald R
        • Gerges M
        • et al.
        Efficacy and Safety of Percutaneous Pulmonary Artery Subtotal Occlusion and Chronic Total Occlusion Intervention in Chronic Thromboembolic Pulmonary Hypertension.
        Circ Cardiovasc Interv. 2021; 14e010243