Abstract
Aims To evaluate safety and efficacy of balloon pulmonary angioplasty (BPA) in a large cohort of patients with chronic thromboembolic pulmonary hypertension (CTEPH).
Methods and results From 2014 to 2017, 184 inoperable CTEPH patients underwent 1006 BPA sessions. Safety and efficacy during the first 21 months (initial period) were compared with those of the last 21 months (recent period). A total of 154 patients had a full evaluation after a median duration of 6.1 months. Overall, there was a significant improvement in NYHA functional class, 6-min walk distance (mean change, +45 m), and a significant decrease in mean pulmonary artery pressure (PAP) and in pulmonary vascular resistance (PVR) by 26% and 43%, respectively. The percentage decrease of mean PAP and PVR were 22% and 37% in the initial period versus 30% and 49% in the recent period, respectively (p<0.05). The main complications included lung injury (LI) which occurred in 9.1% of 1006 sessions (13.3% in the initial period versus 5.9% in the recent period, p<0.001). Per-patient multivariate analysis revealed that baseline mean PAP and the period during which BPA procedure was performed (recent versus initial period) were the strongest factors related to the occurrence of LI. Three-year survival was 95.1%.
Conclusion This study confirms that a refined BPA strategy improves short-term symptoms, exercise capacity and hemodynamics in inoperable CTEPH patients with an acceptable risk-benefit ratio. Safety and efficacy improve over time, underscoring the unavoidable learning curve for this procedure.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. BRENOT has nothing to disclose.
Conflict of interest: Dr. JAIS reports grants and personal fees from Actelion, grants and personal fees from GSK, grants and personal fees from Bayer, grants and personal fees from MSD, outside the submitted work.
Conflict of interest: Dr. Taniguchi has nothing to disclose
Conflict of interest: Dr. GERARDIN has nothing to disclose.
Conflict of interest: Dr. Mussot has nothing to disclose.
Conflict of interest: Dr. mercier has nothing to disclose.
Conflict of interest: Dr. FABRE has nothing to disclose.
Conflict of interest: Dr. PARENT has nothing to disclose.
Conflict of interest: Dr. Jevnikar has nothing to disclose.
Conflict of interest: Dr. MONTANI reports grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from GSK, personal fees from Pfizer, personal fees from BMS, personal fees from MSD, outside the submitted work.
Conflict of interest: Dr. Savale reports grants, personal fees and non-financial support from Actelion, grants, personal fees and non-financial support from GSK, personal fees and non-financial support from MSD, outside the submitted work.
Conflict of interest: Dr. SITBON reports grants, personal fees and non-financial support from Actelion Pharmaceuticals, grants and personal fees from Bayer HealthCare, grants and non-financial support from Merck, grants, personal fees and non-financial support from GlaxoSmithKline, personal fees from Arena Pharmaceuticals, outside the submitted work.
Conflict of interest: Dr. fadel has nothing to disclose.
Conflict of interest: Dr. HUMBERT reports grants and personal fees from Actelion , grants and personal fees from Bayer , grants and personal fees from GSK, personal fees from Johnson & Johnson, grants and personal fees from MSD, personal fees from United Therapeutics, outside the submitted work.
Conflict of interest: Dr. SIMONNEAU reports grants, personal fees and non-financial support from Actelion Pharmaceuticals, grants, personal fees and non-financial support from Bayer Healthcare, grants, personal fees and non-financial support from Merck, grants, personal fees and non-financial support from GlaxoSmithKline, outside the submitted work.
Conflict of interest: Dr. GARCIA ALONSO has nothing to disclose.
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