Abstract 10190: Recurrent Pulmonary Hypertension After Balloon Pulmonary Angioplasty in Patients With Inoperable Thromboembolic Pulmonary Hypertension

Abstract

Backgrounds: Balloon pulmonary angioplasty (BPA) improves hemodynamics and prognosis in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Though it has been reported that recurrent pulmonary hypertension (PH) after pulmonary endarterectomy is rare, the recurrence rate of PH after BPA remains to be clarified. In this study, we examined the frequency of recurrent PH after BPA in the long-term period and the risk factors. Methods: We retrospectively reviewed consecutive 200 CTEPH patients (65±12yrs., Male 43(22%)) who completed BPA procedures from July 2009 to December 2020 and had hemodynamic evaluation after the procedures and extracted the patients with recurrent PH who had a mean pulmonary arterial pressure (mPAP) <25 mm Hg after BPA and developed PH (mPAP ≥25 mm Hg) during follow-up and had a clinical deterioration requiring additional treatment. As risk factors for recurrent PH, we investigated the known risk factors for the development of CTEPH, and the types of oral anticoagulants (warfarin or direct oral anticoagulant). Results: The median follow-up period from final BPA session was 42 [24,62] months. BPA significantly improved mPAP (39±10 to 22±5mmHg, P<0.01) and cardiac output (CO) (3.6±1.1 to 4.1±1.1 L/min, P<0.01). Recurrent PH was observed in 13 of the 200 patients (6.5%) during the follow-up period and the estimated 5-year recurrence rate was 8.9%. The median period from final BPA to recurrence was 20 months [12,47 months], and 6 cases (46%) recurred PH within a year after BPA. In these patients, mPAP deteriorated from 21±2 to 29±5mmHg (P<0.01) but not CO (4.07±0.69 to 3.81±0.50L/min, P=0.46). Of the 13 recurrent PH patients, 9 required additional BPA, and 6 required additional medication. However, the 5-year survival in the recurrent PH and non-recurrent PH groups were comparable (100% and 96.1%, P=0.50). Any risk factors for recurrent PH were not detected. The recurrence rate of PH in those with direct oral anticoagulant (83 cases (42%)) was similar to that in those with warfarin (3.6% and 8.6%, P=0.16). Conclusions: Recurrent PH after BPA is rare and not associated with the known risk factors for CTEPH. The prognosis in the recurrent PH group with additional treatments is similar to that in the non-recurrent group.