Abstract 14011: Safety of Balloon Pulmonary Angioplasty in Patients With Inoperable Chronic Thromboembolic Pulmonary Hypertension -Detail Analyses of Procedure Related Complications

Abstract

Background: Although balloon pulmonary angioplasty (BPA) is an emerging therapeutic strategy to improve hemodynamics of patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), the original study in 2001 reported that BPA frequently induced pulmonary edema requiring mechanical ventilation. In this study, to evaluate the safety of BPA in CTEPH patients, we examined not only hemodynamics but also complications associated with latest BPA procedures by using imaging modalities. Methods and Results: From July 2009 to May 2016, we performed BPA in 78 patients with inoperable CTEPH, in whom we performed 393 sessions with combined use of imaging modalities, including optical computed tomography to select balloon size and 3D reconstructed computed tomography to determine target lesions of pulmonary arteries (PA). Mean age of the patients was 65 year-old and 65 of them were female (82%). In 72 patients (92%) who completed the treatment, hemodynamics and 5-year survival were examined after BPA. Mean follow-up period was 21 ± 15 months. After the completion of BPA treatments, mean PA pressure (38±10 to 25±7 mmHg, P<0.01), pulmonary vascular resistance (7.0±3.1 to 3.7±1.7 Wood unit) and 6-min walk distance (383±156 to 489±113 meters) were all significantly improved (all P<0.01). In the 393 sessions, hemoptysis was noted in 64 sessions (16%), and non-invasive positive pressure ventilation (NPPV) was used for hemoptysis and/or hypoxemia in 32 sessions (8.1%). In last 4 years, the incidence of hemoptysis and the use of NPPV have progressively decreased (Figure). Furthermore, there were no peri-procedural deaths, and 5-year survival after 1st BPA session was 94% (only one patient died for colon cancer). Conclusions: These results indicate that BPA improves hemodynamics and exercise capacity, resulting in good long-term prognosis in inoperable CTEPH patients with acceptable complication risk.