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Balloon Pulmonary Angioplasty (BPA) is emerging as a viable treatment for Chronic Thromboembolic Pulmonary Hypertension (CTEPH), although the potential benefits and safety of BPA have not been fully described in a truly non-surgical cohort of patients employing strict selection criteria to decide management determined at a multi-disciplinary team meeting. We assessed the clinical results of a focused BPA approach, treating disease largely confined to basal sub-segmental arteries (A8-10), in a truly non-surgical CTEPH population.
Twenty (7%) of CTEPH referrals were selected for BPA from October 2015 to June 2017. Preoperative assessment included WHO functional class (FC), right heart catheterisation, cardiopulmonary exercise test (CPET), distance covered on a 6-minute walk test (6MWT), pro-NT brain natriuretic peptide (pro-NT BNP) level and RV function and dimensions by transthoracic echocardiography. These measurements were repeated at 3-months (where possible) after completion of treatment and compared. Pulmonary vasodilator therapy remained unchanged during this period.
Fifty-six procedures were performed in 20 patients (mean age 64, 13 male, median 3 procedures per patient) treating 107 vessels (Left A8 – 18, A9 – 16, A10 – 14, other – 2; Right A8 – 20, A9 – 10, A10 – 18, other – 9) with a semi-compliant balloon diameter of <4mm inflated to <6atm. We observed 6 complications: 3 femoral haematoma, 1 small lung hemorrhage, 1 mild haemoptysis and 1 mild lung reperfusion injury but no major complications or deaths occurred. Baseline and 3-month data (Table *n=13 completed follow-up) indicate improvements in haemodynamic, exercise capacity, RV function and WHO FC indices.
|CO Thermo, L/min||4.6±1.1||5.0±1.2||0.28|
|PVR Thermo, Dynes.cm-5||652±260||398±151||0.0001|
|VO2 max, ml/min/kg||17.4±5.0||18.1±4.0||0.93|
|Pro-NT BNP, pg/mL||1094±1794||411±687||0.07|
Focused BPA, targeting lesions in the basal sub-segmental pulmonary arteries that receive the most pulmonary blood flow, achieves clinically important benefits with relatively few treatments required per-patient and few complications.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention