BPA for CTEPH: the Viennese experience

Abstract

Purpose: Chronic thromboembolic pulmonary hypertension (CTEPH) results from non-resolving thrombi in pulmonary arteries. About 40-50% of patients are not eligible for pulmonary endarterectomy (PEA) due to distal lesions or significant comorbidities. In addition, 17-51% of patients experience persistent or recurrent pulmonary hypertension (PH) after PEA. Balloon pulmonary angioplasty (BPA) is an emerging percutaneous method for patients with inoperable CTEPH or persistent PH after PEA. In the Austrian CTEPH reference center (8.3 million population) a BPA program was initiated in April 2014. Methods: 120 patients (106 inoperable and 14 persistent PH after PEA) underwent 690 BPA procedures until October 2019. Clinical features and hemodynamics were assessed at baseline and 6 months after the last BPA session. Results: 45 patients (39 inoperable and 6 persistent PH after PEA) finished BPA treatment after 6.8±3.4 procedures. There was a significant improvement in WHO functional class (median change -1 [-2,-1]), 6-minute walk distance (median change 127 [45,184]), Nt-proBNP (median change -222 [-1037,-6]), and a significant decrease in mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance by -30±21% and -26±24% (all p Conclusion: Our data confirm that BPA improves symptoms and hemodynamics in patients with CTEPH. In addition, BPA is equally effective in inoperable CTEPH and persistent PH.