Complicaciones relacionadas a la angioplastia pulmonar con balón

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.

¿Han cambiado las complicaciones relacionadas a la angioplastia pulmonar con balón desde sus inicios?

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%.

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.