Abstract
Background: Balloon pulmonary angioplasty (BPA) has been shown to markedly improve both exercise capacity and pulmonary hemodynamics in patients with inoperable chronic thromboembolic pulmonary hypertension (CETPH). Since 2009, we have adopted BPA as a first-line treatment strategy for inoperable CTEPH. The aim of this study was to evaluate the long-term efficacy of BPA in patients with inoperable CTEPH. Methods and Results: From 1992 to 2014, we treated a total of 110 patients with inoperable CTEPH at our Hospital. Among them, we excluded 11 patients from the present analysis due to advanced cancer or multiple organ failure at admission. We divided the remaining 99 patients into 2 groups; the historical control (HC) group (N=35; mean age, 62 years; M/F = 30/5) who were admitted from 1992 to 2008 and the BPA group (N= 64; mean age, 64 years; M/F= 49/15) who were admitted from 2009 to 2014. We compared baseline characteristics, hemodynamics and long-term survival between the 2 groups. There was no significant difference in baseline parameters, including age, sex, WHO functional class or serum BNP levels between the 2 groups. Regarding hemodynamic parameters, the BPA group had significantly higher pulmonary capillary wedge pressure compared with the HC group (9±0.4 vs. 7±0.6 mmHg, P<0.01). The median follow-up period was 53 months (IQR 26-80 months) for the HC group and 23 months (IQR 13-39 months) for the BPA group. Kaplan-Meier analysis showed that the survival rate was significantly better in the BPA group compared with the HC group (log-rank P=0.02), with the estimated 5-year survival probability of 98% for the BPA group and 73% for the HC group ( Figure ). The multiple Cox hazard analysis showed that both age (hazard ratio 1.07, P=0.02) and the HC group (hazard ratio 9.2, P=0.01) were independent predictor of mortality. Conclusions: These results indicate that BPA has a beneficial impact on long-term survival in patients with inoperable CTEPH.
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