Temporal Trends in Age Profile and Safety of Balloon Pulmonary Angioplasty for CTEPH

Balloon pulmonary angioplasty (BPA) techniques have been refined and increasingly adopted for chronic thromboembolic pulmonary hypertension.

This study aimed to evaluate the temporal trends in BPA safety, with a focus on outcomes in older patients.

Using the Japanese Cardiovascular Disease All-Case Registry (2013-2022), we retrospectively analyzed 14,429 BPA procedures performed on 3,700 patients (median age, 68 years). The study period was divided into early (2013-2017) and late (2018-2022) periods. Patient characteristics and major complication rates were evaluated for each period. Complications were defined as a composite of major adverse events occurring within 30 days: death, mechanical ventilation, extracorporeal membrane oxygenation, continuous hemodiafiltration, transfusion, cardiac tamponade, or surgery.

Patients treated in the late period were older (P < 0.001). The complication rate decreased from 7.8% in the early period to 4.2% in the late period (P < 0.001). In multivariable analysis, the adjusted OR of complications was lower in the late period (OR: 0.411; 95% CI: 0.247-0.675). The adjusted complication risk decreased across all age categories in the late period. An age-dependent increase in the adjusted complication risk was observed across all periods (trend P = 0.002), significant in the early (trend P = 0.015) but not in the late (trend P = 0.085) period.

BPA safety has improved over time. Despite higher complication risks in older patients, the narrowing gap with younger patients in recent years suggests that BPA is a safe and feasible option for this population.