Aiko Ogawa1, Toru Satoh1, Tetsuya Fukuda1, Koichiro Sugimura1, Yoshihiro Fukumoto1, Noriaki Emoto1, Norikazu Yamada1, Atsushi Yao1, Motomi Ando1, Hitoshi Ogino1, Nobuhiro Tanabe1, Ichizo Tsujino1, Masayuki Hanaoka1, Kenji Minatoya1, Hiroshi Ito1, Hiromi Matsubara2. 1. From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan (Y.F.); Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan (N.E.); Department of Clinical Pharmacy, Kobe Pharmaceutical University, Japan (N.E.); Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan (N.Y.); Division for Health Service Promotion, University of Tokyo, Japan (A.Y.); Department of Cardiovascular Surgery, Cardiovascular Center, Daiyukai General Hospital, Ichinomiya, Japan (M.A.); Department of Cardiovascular Surgery, Tokyo Medical University, Japan (H.O.); Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Japan (N.T.); First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan (I.T.); First Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan (M.H.); and Department of Cardiovascular Medicine, Okayama University, Japan (H.I.). 2. From the Department of Clinical Science, National Hospital Organization Okayama Medical Center, Japan (A.O., H.M.); Division of Cardiology, Department of Medicine, Kyorin University School of Medicine, Tokyo, Japan (T.S.); Department of Radiology (T.F.) and Department of Cardiovascular Surgery (K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (K.S.); Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan (Y.F.); Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan (N.E.); Department of Clinical Pharmacy, Kobe Pharmaceutical University, Japan (N.E.); Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan (N.Y.); Division for Health Service Promotion, University of Tokyo, Japan (A.Y.); Department of Cardiovascular Surgery, Cardiovascular Center, Daiyukai General Hospital, Ichinomiya, Japan (M.A.); Department of Cardiovascular Surgery, Tokyo Medical University, Japan (H.O.); Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Japan (N.T.); First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan (I.T.); First Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan (M.H.); and Department of Cardiovascular Medicine, Okayama University, Japan (H.I.). matsubara.hiromi@gmail.com.
Abstract
BACKGROUND: Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy-the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present study evaluated the safety and efficacy of BPA for chronic thromboembolic pulmonary hypertension based on a multicenter registry. METHODS AND RESULTS: A total of 308 patients (62 men and 246 women; mean age, 61 years) underwent 1408 procedures at 7 institutions in Japan. Data were retrospectively reviewed to evaluate clinical outcome and complications. Hemodynamics were significantly improved in 249 patients in whom BPA was terminated, most often because of improvement in mean pulmonary arterial pressure or symptomatic improvement after 1154 procedures. In 196 patients who underwent follow-up right heart catheterization, improvement of hemodynamic parameters was maintained. Mean pulmonary arterial pressure decreased from 43.2±11.0 to 24.3±6.4 mm Hg after final BPA and 22.5±5.4 mm Hg at follow-up, with significant reduction of concomitant use of pulmonary hypertension-targeted therapy and oxygen supplementation. Complications occurred in 511 (36.3%), including pulmonary injury (17.8%), hemoptysis (14.0%), and pulmonary artery perforation (2.9%). Twelve patients (3.9%) died during follow-up, including 8 patients who died within 30 days after BPA. The leading causes of death were right heart failure, multiorgan failure, and sepsis. Overall survival was 96.8% (95% confidence interval, 93.7%-98.4%) at 1 and 2 years and 94.5% (95% confidence interval, 89.3%-97.3%) at 3 years, respectively, after the initial BPA procedure for all 308 patients. CONCLUSIONS: This multicenter registry suggested improved hemodynamic results after BPA. Complication rates were high, but overall survival was comparable with pulmonary endarterectomy. BPA may be an important therapeutic option in patients with chronic thromboembolic pulmonary hypertension.
BACKGROUND:Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy-the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present study evaluated the safety and efficacy of BPA for chronic thromboembolic pulmonary hypertension based on a multicenter registry. METHODS AND RESULTS: A total of 308 patients (62 men and 246 women; mean age, 61 years) underwent 1408 procedures at 7 institutions in Japan. Data were retrospectively reviewed to evaluate clinical outcome and complications. Hemodynamics were significantly improved in 249 patients in whom BPA was terminated, most often because of improvement in mean pulmonary arterial pressure or symptomatic improvement after 1154 procedures. In 196 patients who underwent follow-up right heart catheterization, improvement of hemodynamic parameters was maintained. Mean pulmonary arterial pressure decreased from 43.2±11.0 to 24.3±6.4 mm Hg after final BPA and 22.5±5.4 mm Hg at follow-up, with significant reduction of concomitant use of pulmonary hypertension-targeted therapy and oxygen supplementation. Complications occurred in 511 (36.3%), including pulmonary injury (17.8%), hemoptysis (14.0%), and pulmonary artery perforation (2.9%). Twelve patients (3.9%) died during follow-up, including 8 patients who died within 30 days after BPA. The leading causes of death were right heart failure, multiorgan failure, and sepsis. Overall survival was 96.8% (95% confidence interval, 93.7%-98.4%) at 1 and 2 years and 94.5% (95% confidence interval, 89.3%-97.3%) at 3 years, respectively, after the initial BPA procedure for all 308 patients. CONCLUSIONS: This multicenter registry suggested improved hemodynamic results after BPA. Complication rates were high, but overall survival was comparable with pulmonary endarterectomy. BPA may be an important therapeutic option in patients with chronic thromboembolic pulmonary hypertension.
Authors: Sabine K Maschke; Jan B Hinrichs; Julius Renne; Thomas Werncke; Hinrich M B Winther; Kristina I Ringe; Karen M Olsson; Marius M Hoeper; Frank K Wacker; Bernhard C Meyer Journal: Eur Radiol Date: 2018-09-12 Impact factor: 5.315