For patients with inoperable or residual postendarterectomy chronic thromboembolic pulmonary hypertension, performing a balloon pulmonary angioplasty provided improvements in pressure measurements, functional class, and exercise capacity with an acceptable risk profile, according to a study published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.
The aim of this retrospective study was to evaluate the efficacy and safety of completing balloon pulmonary angioplasty procedure in patients with inoperable or residual postendarterectomy chronic thromboembolic pulmonary hypertension at the Mayo Clinic between August 11, 2014, and May 17, 2018. Data for patients with diagnosed chronic thromboembolic pulmonary hypertension, including details of procedures, hemodynamic data, echocardiographic data, laboratory values, and clinical data, were recorded before the balloon pulmonary angioplasty procedure. The balloon pulmonary angioplasty sessions were completed in a stepwise fashion to reduce complications and meet the goal of improved clinical measurements or a mean reduction in pulmonary artery pressure of <30 mm Hg. Data were collected post-procedure to assess changes in hemodynamic and functional measurements.
Of the 31 patients included in this study, 41.9% were women, the mean age was 59.7 years old, 26 had inoperable chronic thromboembolic pulmonary hypertension, 5 had residual postendarterectomy chronic thromboembolic pulmonary hypertension, and the median number of balloon pulmonary angioplasty sessions was 2 with a median number of 3 lesions treated per session.
Patients experienced significant improvements in mean pulmonary arterial pressures (P <.001), pulmonary vascular resistance (P <.001), right ventricular systolic pressure (P <.001), pulmonary arterial systolic and diastolic pressure (P <.001), and right atrial pressure (P =.03).
From pre- to post-procedure, 61.3% of patients improved their New York Heart Association functional class, and the 6-minute walk test improved in the 13 patients who performed the test at both time points (P =.001).
Additionally, the N-terminal pro-B-type natriuretic peptide level decreased in the 18 patients who were evaluated at both time points (P =.18), and ventilator efficiency improved in the 16 patients who were evaluated for metabolic equivalents at both time points (P =.04).
The rates of complications from this procedure were low, with 2 cases of self-limited scant hemoptysis, 1 case of severe hemoptysis, 1 case of cardiac tamponade, and 1 case of pulmonary reperfusion injury. The rate of serious complications was 4%.
Limitations of this study include its retrospective nature, not having complete follow-up results from all patients, and the fact that short-term follow-up might not provide all the results of interest.
The researchers concluded that balloon pulmonary angioplasty “has acceptable risk and improves hemodynamics, functional class, and exercise tolerance in patients with inoperable or residual [chronic thromboembolic pulmonary hypertension].”
Anand V, Frantz RP, DuBrock H, et al. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: initial single-center experience. Mayo Clin Proc Innov Qual Outcomes. 2019;3(3):311-318.