Long-Term Survival of Balloon Pulmonary Angioplasty for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A...

Balloon pulmonary angioplasty (BPA) is recommended for inoperable chronic thromboembolic pulmonary hypertension (CTEPH).

The aim of this study was to evaluate the long-term survival benefit of BPA for inoperable CTEPH, especially partial BPA sessions.

In this multicenter cohort study, 232 patients undergoing BPA (the BPA group) and 70 patients refusing the BPA procedure (the non-BPA group) were enrolled. The BPA group was further divided into the full-BPA group (129 patients) and the partial-BPA group (103 patients). The primary outcome was all-cause mortality.

During a median follow-up time of 6.0 years (Q1-Q3: 3.7-7.3), 17 and 26 patients in the BPA and non-BPA groups died, contributing to 8-year survival rates of 86.7% (95% CI: 80.1%-93.8%) and 57.8% (95% CI: 45.9%-72.8%) in the BPA and non-BPA groups, respectively (P < 0.001, log-rank test). BPA was associated with significantly reduced all-cause mortality in inoperable CTEPH patients (HR: 0.20; 95% CI: 0.12-0.32; P < 0.001). In secondary analysis, the 8-year survival rates were 97.1% (95% CI: 93.8%-99.9%) and 70.0% (95% CI: 55.8%-87.8%) in the full-BPA and partial-BPA groups, respectively, both better than the non-BPA group (P < 0.001, log-rank test). Compared with the non-BPA group, partial BPA was associated with significantly reduced all-cause mortality in inoperable CTEPH patients (HR: 0.38; 95% CI: 0.22-0.70; P = 0.001).

BPA tended to be associated with a reduced risk for all-cause mortality in patients with inoperable CTEPH, even those undergoing partial BPA sessions. These findings are preliminary and must be confirmed in randomized controlled trials.