Abstract
<h3>Purpose</h3> Pulmonary endarterectomy (PEA) is the recommended treatment for patients with operable CTEPH. Balloon pulmonary angioplasty (BPA) is an emerging treatment option for inoperable patients with good preliminary results. Although deemed operable, we see more and more patients reluctant to surgery and referred to BPA. To evaluate efficacy of BPA in proximal disease, we reviewed our experience and compared results in patients who refused surgery (rPEA) to those with severe comorbidities preventing surgery (cBPA). <h3>Methods</h3> We retrospectively reviewed all CTEPH patients treated by BPA in our National Referral Center. From 2014 to 2020, 220 patients were included and assessed clinically and hemodynamically after completion of BPA treatment. Among them 36 (16%) had on angio CT a proximal disease as evaluated by our expert CTEPH multidisciplinary team: 27 (75%) were in the cBPA group and 9 in the rPEA group. <h3>Results</h3> Before BPA, pulmonary hypertension (PH) severity and the number of patients on PH targeted therapy was similar in both groups. There was no significant difference in the number of BPA sessions (6 vs. 5) and in duration of follow-up (10.7 months vs. 13.2 months) between the rPEA the cBPA groups (p=NS). Clinically, we found a significant improvement in the cBPA group (NYHA status: II vs. III; p=0.03 and 6MWT: 383 vs. 238 m; p=0.08) and not in the rPEA group (NYHA II vs. II; p=0.7 and 6MWT 409 vs. 376 m; p=0.8). Similarly, hemodynamic data improved in the cBPA group (mean PAp: 30 vs. 42 mmHg, p<0.001; CO: 5.9 min vs 4.7 L/min; p=0.1; PVR 3.3 vs 5.7 WU, p<0.001) but not in the rPEA group (mean PAp 25 vs. 35mmHg, p=0.15; CO 4.3 vs. 3.9 L/min, p=0.37; PVR 3.9 vs. 5.9 WU, p=0.18). <h3>Conclusion</h3> BPA for CTEPH patients with proximal disease is associated with better outcome in patients contraindicated to surgery because of severe comorbidities than in patients who refused PEA. When feasible, PEA remains the treatment of choice of CTEPH patients. Further prospective studies are needed to confirm these results
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