Safety and efficacy of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension in the Netherlands.

M C J Van Thor,R J Lely,R J Snijder,A Vonk Noordegraaf,R H Heijmen,J J Mager,E J Nossent,N J Braams,P Symersky,B J W M Rensing,L Ten Klooster,M C Post,M A M Beijk,L J Meijboom,D A F Van Den Heuvel,H J Bogaard

doi:10.1007/s12471-019-01352-6

Abstract

BackgroundBalloon pulmonary angioplasty (BPA) is an emerging treatment in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic disease (CTED). We describe the first safety and efficacy results of BPA in the Netherlands.MethodsWe selected all consecutive patients with inoperable CTEPH and CTED accepted for BPA treatment who had a six-month follow-up in the St. Antonius Hospital in Nieuwegein and the Amsterdam University Medical Center (UMC) in Amsterdam. Functional class (FC), N‑terminal pro-brain natriuretic peptide (NT-proBNP), 6‑minute walking test distance (6MWD) and right-sided heart catheterisation were performed at baseline and six months after last BPA. Complications for each BPA procedure were noted.ResultsA hundred and seventy-two BPA procedures were performed in 38 patients (61% female, mean age 65 ± 15 years). Significant improvements six months after BPA treatment were observed for functional class (63% FC I/II to 90% FC I/II, p = 0.014), mean pulmonary artery pressure (−8.9 mm Hg, p = 0.0001), pulmonary vascular resistance (−2.8 Woods Units (WU), p = 0.0001), right atrial pressure (−2.0 mm Hg, p = 0.006), stroke volume index (+5.7 ml/m2, p = 0.009) and 6MWD (+48m, p = 0.007). Non-severe complications occurred in 20 (12%) procedures.ConclusionsBPA performed in a CTEPH expert centre is an effective and safe treatment in patients with inoperable CTEPH.

Highlights

Chronic thromboembolic pulmonary hypertension (CTEPH) is a pulmonary artery disease caused by chronic thromboembolisms, leading to pulmonary hypertension despite the use of anticoagulation
A hundred and seventy-two Balloon pulmonary angioplasty (BPA) procedures were performed in 38 patients (61% female, mean age 65 ± 15 years)
Significant improvements six months after BPA treatment were observed for functional class (63% Functional class (FC) I/II to 90% FC I/II, p = 0.014), mean pulmonary artery pressure (–8.9 mm Hg, p = 0.0001), What’s new Balloon pulmonary angioplasty in inoperable chronic thromboembolic pulmonary hypertension significantly improves symptoms, exercise capacity and pulmonary haemodynamics

Summary

Introduction

Chronic thromboembolic pulmonary hypertension (CTEPH) is a pulmonary artery disease caused by chronic thromboembolisms, leading to pulmonary hypertension despite the use of anticoagulation. When CTEPH patients are technically operable, i.e. in central or segmental disease, pulmonary endarterectomy is the treatment of choice [2, 3]. Patients who are considered inoperable, based on a distal localisation of chronic thromboembolisms or due to comorbidities resulting in a nonacceptable riskbenefit ratio, are currently treated with pulmonary hypertension specific medication [3, 4]. Recent studies reported that balloon pulmonary angioplasty (BPA) might be of value in carefully selected patients [5]. Patients with symptomatic chronic thromboembolic disease (CTED) without pulmonary hypertension, may benefit from BPA [6]. Balloon pulmonary angioplasty (BPA) is an emerging treatment in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic disease (CTED). We describe the first safety and efficacy results of BPA in the Netherlands

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Conclusion