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Refined balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension - reference center experience
Andrzej Łabyk1, Marcin Krakowian1, Łukasz Mysiorski1
1Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland.
Insights
Balloon pulmonary angioplasty (BPA) significantly improves outcomes for chronic thromboembolic pulmonary hypertension (CTEPH) patients. This study shows reduced pressures and improved function with high safety in an experienced center.
Area of Science:
- Cardiology
- Pulmonology
- Interventional Radiology
Background:
- Chronic thromboembolic pulmonary hypertension (CTEPH) involves pulmonary artery obstruction, leading to heart dysfunction and mortality.
- Balloon pulmonary angioplasty (BPA) has emerged as a key treatment, improving CTEPH patient prognosis.
Purpose of the Study:
- To summarize the experience and outcomes of a dedicated BPA program for CTEPH patients.
- To evaluate the safety and efficacy of BPA in a reference center between 2014 and 2022.
Main Methods:
- Analysis of 55 inoperable CTEPH patients who underwent 226 BPA sessions.
- Utilization of intravascular imaging and pressure catheters during procedures.
Main Results:
- Significant reductions in mean pulmonary pressure (42 to 26.5 mm Hg) and pulmonary vascular resistance (6.67 to 3.295 Wood units).
- Improved WHO functional class (2.85 to 2.15) and 6-minute walking distance (300 to 367 m).
- Low complication rates: 4% arterial damage, 0.9% acute right ventricular failure, no in-hospital deaths.
Conclusions:
- BPA programs in experienced centers offer a safe and effective treatment for inoperable CTEPH.
- BPA demonstrates significant hemodynamic and functional improvements in CTEPH patients.
Introduction:
Chronic thromboembolic pulmonary hypertension (CTEPH), characterized by thromboembolic changes affecting the pulmonary bed, leads to ventricular function deterioration and premature death. The introduction of balloon pulmonary angioplasty (BPA) has significantly improved the prognosis of CTEPH patients.
Aim:
The authors of this article decided to summarize the experience of the BPA program, conducted between 2014 and 2022, at the reference center.
Material And Methods:
Among 111 CTEPH patients, 55 were included in the analysis. A total of 226 sessions were performed, with a significant percentage of intravascular imaging and pressure catheter use.
Results:
Mean pulmonary pressure decreased significantly from 42 (22-66) to 26.5 mm Hg (11-54) (p < 0.05). Pulmonary vascular resistance and natriuretic peptide concentration decreased from 6.67 (1.66-14) to 3.295 Wood units (1.09-11.11), respectively, and from 1934 (60-16963) to 296 (21-9901) ng/ml (p < 0.05). There was also an improvement in the functional class (WHO) from 2.85 ±0.61 to 2.15 ±0.62 and an increase in the 6-minute walking distance from 300 ±131 to 367 ±154 m (p < 0.05). There were no in-hospital deaths or within 30 days of the procedure. Arterial damage occurred during nine sessions (n = 9/226, 4%), while 0.9% (n = 2/226) were complicated by acute right ventricular failure. Post-reperfusion pulmonary edema (RPE 0 - none) was observed in almost 90% of the sessions, grade 1 to 3 RPE occurred in 10.2%, and grade 4 RPE was not noted.
Conclusions:
BPA programs conducted in experienced centers are a safe and effective treatment option for inoperable CTEPH patients.
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