Nobuhiro Tanabe1, Takashi Kawakami2, Toru Satoh3, Hiromi Matsubara4, Norifumi Nakanishi5, Hitoshi Ogino6, Yuichi Tamura7, Ichizo Tsujino8, Aiko Ogawa9, Seiichiro Sakao10, Mari Nishizaki11, Keiichi Ishida12, Yasunori Ichimura13, Masahiro Yoshida14, Koichiro Tatsumi15. 1. Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: ntanabe@faculty.chiba-u.jp. 2. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: kawakami.1650@gmail.com. 3. Division of Cardiology Department of Medicine, Kyorin University Hospital, Mitaka, Japan. Electronic address: tsatoh2008@me.com. 4. Department of Clinical Science, National Hospital Organization, Okayama Medical Center, Okayama, Japan. Electronic address: matsubara.hiromi@gmail.com. 5. Department of Cardiovascular Medicine, Minami Osaka Hospital, Osaka, Japan. Electronic address: nnakanis@hsp.ncvc.go.jp. 6. Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan. Electronic address: hogino@tokyo-med.ac.jp. 7. Division of Cardiovascular Internal Medicine, International University of Health and Welfare, Mita Hospital, Tokyo, Japan. Electronic address: tamura.u1@gmail.com. 8. First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan. Electronic address: itsujino-circ@umin.net. 9. Department of Clinical Science, National Hospital Organization, Okayama Medical Center, Okayama, Japan. Electronic address: aiko-oky@umin.ac.jp. 10. Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: sakaos@faculty.chiba-u.jp. 11. Department of Rehabilitation, National Hospital Organization, Okayama Medical Center, Okayama, Japan. Electronic address: marinishi631@gmail.com. 12. Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: k-ishida@faculty.chiba-u.jp. 13. Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: yichimura@earth.nifty.jp. 14. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Narita, Japan. Electronic address: dr44da@yahoo.co.jp. 15. Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: tatsumi@faculty.chiba-u.jp.
Abstract
BACKGROUND: Balloon pulmonary angioplasty (BPA) has been performed for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual pulmonary hypertension after pulmonary endarterectomy (PEA). We performed a systematic review to assess the efficacy and safety of BPA, especially compared to medical treatment or PEA. METHODS: We reviewed all studies investigating pre- and post-treatment pulmonary hemodynamics, mortality, or complications from three electronic databases (PubMed, Cochrane Library, Japan Medical Abstracts Society) prior to February 2017. From 26 studies retrieved, we selected 13 studies (493 patients): the 10 most recent ones including complete data from each institution, one study of residual pulmonary hypertension, and two studies comparing BPA with medical treatment or PEA. RESULTS: No randomized controlled or prospective controlled studies comparing BPA with medical treatment or PEA were reported. The early mortality of BPA ranged from 0% to 14.3%; lung injury occurred in 7.0% to 31.4% (average sessions, 2.5-6.6). Mean pulmonary arterial pressure decreased from 39.4-56 to 20.9-36 mm Hg, and the 6-min walk distance increased from 191-405 to 359-501 m. The 2-year mortality of 80 patients undergoing BPA was significantly lower compared to 68 patients receiving medical treatment (1.3% vs. 13.2%); the risk ratio was 0.14 (95% confidence interval: 0.03-0.76). No significant difference was observed in the 2-year mortality between BPA (n=97) and PEA (n=63) patients. CONCLUSIONS: This systematic review suggests that BPA improves hemodynamics, has acceptable early mortality, and may improve long-term survival compared with medical treatment in inoperable CTEPH patients.
BACKGROUND:Balloon pulmonary angioplasty (BPA) has been performed for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual pulmonary hypertension after pulmonary endarterectomy (PEA). We performed a systematic review to assess the efficacy and safety of BPA, especially compared to medical treatment or PEA. METHODS: We reviewed all studies investigating pre- and post-treatment pulmonary hemodynamics, mortality, or complications from three electronic databases (PubMed, Cochrane Library, Japan Medical Abstracts Society) prior to February 2017. From 26 studies retrieved, we selected 13 studies (493 patients): the 10 most recent ones including complete data from each institution, one study of residual pulmonary hypertension, and two studies comparing BPA with medical treatment or PEA. RESULTS: No randomized controlled or prospective controlled studies comparing BPA with medical treatment or PEA were reported. The early mortality of BPA ranged from 0% to 14.3%; lung injury occurred in 7.0% to 31.4% (average sessions, 2.5-6.6). Mean pulmonary arterial pressure decreased from 39.4-56 to 20.9-36 mm Hg, and the 6-min walk distance increased from 191-405 to 359-501 m. The 2-year mortality of 80 patients undergoing BPA was significantly lower compared to 68 patients receiving medical treatment (1.3% vs. 13.2%); the risk ratio was 0.14 (95% confidence interval: 0.03-0.76). No significant difference was observed in the 2-year mortality between BPA (n=97) and PEA (n=63) patients. CONCLUSIONS: This systematic review suggests that BPA improves hemodynamics, has acceptable early mortality, and may improve long-term survival compared with medical treatment in inoperable CTEPHpatients.
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