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Balloon pulmonary angioplasty (BPA/PTPA) is a novel promising therapeutic method in CTEPH. Our aim was to prove the safety and efficacy of refined BPA/PTPA driven by combined assessment of intra-arterial anatomy (IVUS/OCT) and physiology (pulmonary pressure ratio, PPR) in “all comers” CTEPH pts.
From July 2014 to March 2017 26 CTEPH pts (mean age 73, 52-88, 13 males) were enrolled to the BPA/PTPA program in our centre according to the following inclusion criteria: (mPAP >30mmHg; WHO class > II). Overall, 26 pts underwent 100 BPA sessions (mean 3 sessions per patient, range 1-12), 245 segmental and subsegmental and lobar pulmonary arteries were dilated (mean 8 vessels per patient, range 1-26). All the angioplasties were performed according to our previously published algorithm (Roik M et al. Int J Cardiol 2016, 203: 228-235).
BPA resulted in clinical and hemodynamic improvement in all enrolled patients (Table 1). All dilated arteries were patent at angiographic reassessment. No significant complications occurred during BPA sessions and follow-up. All treated patients are still alive.
|Pre BPA (N = 26)||p||Post BPA (N = 18)|
|mean PAP, mmHg||44 (31-74)||< 0.01||26 (17 -33)|
|WHO functional class 1/2/3/4||0/0/19/7||< 0.05||8/10/0/0|
|Total BPA sessions||N=100|
|Number of BPA sessions per patient||3 (1-12)||Size of balloon used||1.0 -9.0 mm|
|Number of dilated vessels in whole group||245||Number of dilated vessls per patients||3(1-12)|
|Severe Reperfusion pulmonary oedema (RPE) (%), 5 grade scale||>= 3||1%|
|Arrythmia within 24 hour after BPA (N)||2 (AF)||Worsening of renal function within 72 hours after BPA||2 (CIN)|
|RHF during BPA sessionss||0||Unscheduled hospitalization due to RHF during long term FU/other hospitazliations||3/1(COPD)|
|Death (periprocedural or during follow-up)||0|
Refined BPA with assessment of intrapulmonary physiology using a pressure wire and precise evaluation of anatomy provides hemodynamic and functional improvement, with minimal complications rate in all-comers patients with CTEPH. This observation requires further validation in a large multicenter prospective study.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention