Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension: is Europe behind?
- 1Dept of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
- 2National Hospital Organization, Okayama Medical Center, Okayama, Japan
- Irene M. Lang, Dept of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria. E-mail: irene.lang{at}meduniwien.ac.at
Abstract
Balloon pulmonary angioplasty is gaining ground in Europe http://bit.ly/2m02zXF
From the authors:
We are grateful to the editors to be able to correct an error in the table (the number for lung injury referred to % of sessions) and one in the text (“billion” has been corrected to “million”) of our editorial [1] accompanying the article by Brenot et al. [2], published recently in the European Respiratory Journal. These errors have been corrected in the revised version of the table in the editorial; also see the author correction notice in this issue of the European Respiratory Journal.
We would also like to reply to the correspondence by X. Jaïs and co-workers, referring to our editorial, and further spotlight one of the most outstanding advances in pulmonary vascular treatments over the past decade.
We completely agree with X. Jaïs and co-workers that balloon pulmonary angioplasty (BPA) is an important treatment option for carefully selected patients with chronic thromboembolic pulmonary hypertension (CTEPH), and that at present and in the future, medical, surgical and interventional approaches will be applied in combination to benefit patients and lead them to cure. What is important is that the aim of our editorial was to highlight the French data and comment on their relevance, while discussing important differences, particularly interventional and technical challenges, between European and Japanese patients.
Regarding “multiple errors” in the table, it must be said that Brenot et al. [2] state in their published manuscript that “All patients underwent a comprehensive clinical evaluation before the first BPA (baseline), before each BPA session and 3–6 months after the last BPA”, and not “immediately post-BPA”, as stated in the correspondence. Japanese follow-up data were collected after 425.5±280.9 days [3] and those of the German series derive from after 24 weeks after the final BPA procedure [4].
Regarding incompleteness of haemodynamic data, we deliberately left out wedge pressure numbers as this opens another separate discussion on population-based differences between European and Japanese patients that we did not want to be the subject of our editorial.
Taken together, the French data showed a greater increase in cardiac output than the Japanese data. In European patients, BPA can decrease pulmonary vascular resistance (PVR) through a decrease of mean pulmonary artery pressure (mPAP), and a greater increase of cardiac output. In Japanese patients, BPA can decrease PVR through a proportionally greater decrease of mPAP, with little increase of cardiac output.
Future research will be collaborative and shed light on unresolved issues of pulmonary vascular disease in CTEPH, for example the role of the bronchial circulation in CTEPH and the vascular biology of secondary pulmonary arteriopathy of CTEPH.
Shareable PDF
Supplementary Material
This one-page PDF can be shared freely online.
Shareable PDF ERJ-01639-2019.Shareable
Footnotes
Conflict of interest: I.M. Lang reports grants and personal fees from Actelion and AOP Orphan Pharmaceuticals AG, and personal fees from Ferrer, United Therapeutics, MSD and Medtronic, outside the submitted work.
Conflict of interest: H. Matsubara reports personal fees from Actelion, AOP Orphan Pharmaceuticals AG, Bayer, GlaxoSmithKline, Pfizer Japan, Inc., United Therapeutics, Nippon Shinyaku, Co., Ltd and Kaneka Medix Corporation, outside the submitted work.
Support statement: This work was supported by the Austrian Science Foundation, grant F54 (to I.M. Lang). Funding information for this article has been deposited with the Crossref Funder Registry.
- Received August 21, 2019.
- Accepted August 27, 2019.
- Copyright ©ERS 2019