Mid-term follow-up of balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: An experience in Latin America

Abstract

Objectives To describe the characteristics of patients who undergo balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) and report the mid-term outcomes. Background BPA has been recently introduced in Latin America. Mid-term results have not been published. Methods Prospective Chilean Registry of inoperable CTEPH patients who underwent BPA. Clinical variables were analyzed at baseline, after each procedure and at follow-up. Hemodynamic variables were recorded before and after the last BPA. Results Between August 2016 and September 22, 2019 patients (17 women), 59 +/- 12.7 years, underwent 81 BPA and were followed for as long as 33.1 months (mean 17.3 +/- 7.5). Mean pulmonary artery pressure decreased by 17.4% (51.1 +/- 12 vs. 42.2 +/- 13 mmHg,p= .001), pulmonary vascular resistance by 23.9% (766.7 +/- 351 vs. 583 +/- 346 dynes/s/cm(-5),p= .001), cardiac index increased by 8% (2.3 +/- 0.54 vs. 2.5 +/- 0.54 L/min/m(2),p= .012), N-terminal pro-B-type natriuretic peptide decreased by 73.8% (1,685 +/- 1,045 vs. 441.8 +/- 276 pg/dl,p= .006), and 6-min walk distance improved by 135 m (316.7 +/- 94 vs. 451.1 +/- 113 m,p= .001). One patient (4.5%) developed lung reperfusion injury and four patients (18.2%) had minor bleeding (hemoptysis), after the procedure. There was no mortality associated with BPA. Conclusions Our results confirm that BPA for inoperable CTEPH is a relatively safe procedure that improves clinical and hemodynamic parameters in the mid-term. This therapy should be considered as an alternative, mainly in places where access to PAH therapy or surgery is restricted.