open access

Vol 75, No 7 (2017)
Original articles
Published online: 2017-05-10
Submitted: 2017-03-22
Accepted: 2017-04-27
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Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Marcin Kurzyna, Szymon Darocha, Radosław Pietura, Arkadiusz Pietrasik, Justyna Norwa, Rafał Mańczak, Maria Wieteska, Andrzej Biederman, Hiromi Matsubara, Adam Torbicki
DOI: 10.5603/KP.a2017.0091
·
Kardiol Pol 2017;75(7):645-654.

open access

Vol 75, No 7 (2017)
Original articles
Published online: 2017-05-10
Submitted: 2017-03-22
Accepted: 2017-04-27

Abstract

Background and aim: To assess the safety and efficacy of a refined balloon pulmonary angioplasty (BPA) strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods: There were 157 BPA sessions performed in 56 CTEPH patients (47 non-operable, nine after pulmonary endarterectomy; aged 58.6 ± 17.9 years; 28 females) with severely impaired pulmonary haemodynamics (mean pulmonary artery pressure [mPAP]: 51.3 ± 12.2 mm Hg, pulmonary vascular resistance [PVR]: 10.1 ± 3.9 Wood Units). The first 50 sessions aimed to recanalise chronic occlusions and prevent reocclusion with aggressive anticoagulation. The next 107 sessions aimed to relieve “web” and “ring” lesions using reduced tip load guidewires and less intensive anticoagulation.

Results: There was significant reduction in haemoptysis (22% vs. 7%, p = 0.01), vessel injury (30% vs. 13%, p = 0.01), and reperfusion pulmonary injuries (22% vs. 4%, p = 0.01) after changing the BPA strategy. Mortality at 14 days was also reduced (6% vs. 0%; p = 0.05). The cumulative survival rate was 94.6% at 24 months after the first BPA, which was more favourable than medically treated historic controls. In the 31 patients with > 3 BPA sessions, there was significant reduction of PVR (10.3 ± 3.7 vs. 5.9 ± 2.8 Wood Units; p = 0.01), mPAP (50.7 ± 10.8 vs. 35.6 ± 9.3 mm Hg; p = 0.01) and improvement in World Health Organisation functional class (3.19 ± 0.48 vs. 1.97 ± 0.80; p < 0.001).

Conclusions: Balloon pulmonary angioplasty improves haemodynamics and outcome but requires refined strategy to limit early complication rate.

Abstract

Background and aim: To assess the safety and efficacy of a refined balloon pulmonary angioplasty (BPA) strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods: There were 157 BPA sessions performed in 56 CTEPH patients (47 non-operable, nine after pulmonary endarterectomy; aged 58.6 ± 17.9 years; 28 females) with severely impaired pulmonary haemodynamics (mean pulmonary artery pressure [mPAP]: 51.3 ± 12.2 mm Hg, pulmonary vascular resistance [PVR]: 10.1 ± 3.9 Wood Units). The first 50 sessions aimed to recanalise chronic occlusions and prevent reocclusion with aggressive anticoagulation. The next 107 sessions aimed to relieve “web” and “ring” lesions using reduced tip load guidewires and less intensive anticoagulation.

Results: There was significant reduction in haemoptysis (22% vs. 7%, p = 0.01), vessel injury (30% vs. 13%, p = 0.01), and reperfusion pulmonary injuries (22% vs. 4%, p = 0.01) after changing the BPA strategy. Mortality at 14 days was also reduced (6% vs. 0%; p = 0.05). The cumulative survival rate was 94.6% at 24 months after the first BPA, which was more favourable than medically treated historic controls. In the 31 patients with > 3 BPA sessions, there was significant reduction of PVR (10.3 ± 3.7 vs. 5.9 ± 2.8 Wood Units; p = 0.01), mPAP (50.7 ± 10.8 vs. 35.6 ± 9.3 mm Hg; p = 0.01) and improvement in World Health Organisation functional class (3.19 ± 0.48 vs. 1.97 ± 0.80; p < 0.001).

Conclusions: Balloon pulmonary angioplasty improves haemodynamics and outcome but requires refined strategy to limit early complication rate.

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Keywords

balloon pulmonary angioplasty, chronic thromboembolic pulmonary hypertension, complications, survival, haemoptysis

About this article
Title

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 75, No 7 (2017)

Pages

645-654

Published online

2017-05-10

DOI

10.5603/KP.a2017.0091

Bibliographic record

Kardiol Pol 2017;75(7):645-654.

Keywords

balloon pulmonary angioplasty
chronic thromboembolic pulmonary hypertension
complications
survival
haemoptysis

Authors

Marcin Kurzyna
Szymon Darocha
Radosław Pietura
Arkadiusz Pietrasik
Justyna Norwa
Rafał Mańczak
Maria Wieteska
Andrzej Biederman
Hiromi Matsubara
Adam Torbicki

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