Balloon pulmonary angioplasty: Evolution over time and its complications
Balloon pulmonary angioplasty (BPA) has grown from its beginnings as an indication for patients with chronic thromboembolic pulmonary hypertension (CTEPH) to being currently a class 1 indication for inoperable patients and/or residual CTEPH. Current evidence on this topic is underpowered, as most reports are based on a small number of patients.
Researchers conducted a systematic review on papers reporting on BPA and its results. In addition, the rate of complications related to BPA was analyzed for two time periods, 2013-2017 and 2018-2022.
The primary endpoint (PEP) was the incidence of BPA-related complications, defined as vessel injury or hemoptysis, use of mechanical ventilation, or procedure-related death.
The analysis included a total of 1714 CTEPH patients, who accounted for a total of 7561 BPA sessions. The mean follow-up was 7.3 months after the procedure. Results showed that the incidence of hemoptysis or vessel injury was 11.1%, the rate of reperfusion edema was 6%, the rate of mechanical ventilation was 0.4%, and the mortality rate was 1.3%.
Read also: AQCA Study: Pre-PCI Virtual QFR for Planning PCI vs. Conventional Angiography.
When complications were analyzed over the two time periods, the cumulative incidence of hemoptysis and vessel injury decreased from 14.1% to 7.7% (p < 0.01), reperfusion edema decreased from 11.3% to 1.4% (p < 0.01), mechanical ventilation decreased from 0.7% to 0.1% (p < 0.01), and even mortality decreased from 2% to 0.8% (p < 0.01).
Conclusion
BPA is running its natural course, becoming a safe procedure as time goes by. Further research is needed to improve procedural technique, patient selection, and treated lesion characteristics.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: Periprocedural Complications With Balloon Pulmonary Angioplasty Analysis of Global Studies
Reference: Nishant Jain, MD et al J Am Coll Cardiol Intv 2023.
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