Original title: Refined Balloon Pulmonary Angioplasty for Inoperable Patients with Chronic Thromboembolic Pulmonary Hypertension. Reference: Hiroki Mizoguchi et al. Circ Cardiovasc Interv. 2012;5:748-755.
Patients with Chronic Thromboembolic Pulmonary Hypertension (CTE-PH) have bad prognosis. Pulmonary thromboendarterectomy can significantly reduce pulmonary pressure but, due to comorbidity or technical matters (very peripheral thrombi), not all patients are good candidates for this procedure. Angioplasty to the pulmonary branches of these inoperable patients has not been completely accepted yet.
This study included 68 consecutive inoperable patients with type III-IV CTE-PH treated with warfarin, supplemental oxygen and >1 pulmonary vasodilator. To reduce complications, the procedure was performed in stages (average 4) and balloon size was determined using intravascular ultrasound (IVUS).
One of the patients died after procedure because of right heart failure. 64 of the rest of patients (96%) were in CT I-II. Mean pulmonary artery pressure improved significantly, as well as the walk test, natriuretic peptide level, cardiac rate, and supplemental oxygen and vasodilator requirements. The most frequent complication was reperfusion injury, which required mechanical ventilation in 6% of patients.
At ± 0,9 year follow up, 57 patients underwent right heart catheterization; improvement of mean pulmonary arterial pressure was observed (24 ± 5,8 mmHg) and pulmonary arteries presented larger diameter. At 2.2 ± 1.4 yr follow up, 66 patients were alive (97%).
Conclusion
Patients with inoperable CTE-PH can benefit from balloon pulmonary angioplasty (BPA).
Editorial Comment:
This is the first study that involves a reasonable number of patients and shows that BPA is a viable therapeutic alternative and initial results continued in time. It contributes to previous research on the careful selection of balloon size to avoid dissection and perforation and stages to avoid reperfusion injury. A randomized controlled study may be necessary to compare efficacy, safety and costs.
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