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Safety of balloon pulmonary angioplasty for CTEPH: Initial single center Portuguese experience
Session:
CO11 - Circulação Pulmonar / Congénitos
Speaker:
Daniel Sebaiti
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Daniel Sebaiti; Filipa Ferreira; Rita Calé; Maria José Loureiro; Sofia Alegria; Silvia Vitorino; Pedro Santos; Débora Repolho; Gonçalo Jácome Morgado; Helder Pereira
Abstract
<p><strong>Introduction: </strong>Balloon pulmonary angioplasty (BPA) is an emerging therapeutic strategy for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, it is a complex procedure and not risk free.</p> <p><strong>Purpose:</strong> We aimed to determine procedural safety for BPA in patients with inoperable, recurrent or residual CTEPH.</p> <p><strong>Methods</strong>: Detailed procedural and technical aspects were collected for consecutive patients with inoperable, residual or recurrent CTEPH undergoing BPA at a single institution from December 2017 to December 2018.</p> <p><strong>Results</strong>: A total of 57 BPA sessions in 12 patients were performed (age 64.1±10.7 years; 67% women; pre-BPA mean pulmonary artery pressure (mPAP) 30.8±10.3 mmHg). Femoral access was used for all patients. 230 vessels were treated in 139 segments. Ring-like stenosis, webs, subtotal occlusions, and total occlusions were noted in 16 (7%), 164 (71%), 31 (13%) and 18 (8%) treated vessels, respectively. Average number of treated vessels per session was 4.0±1.9 in 2.4±1.0 segments. We performed 11 pressure-wire guided sessions for patients with mPAP>40 mmHg. Intravascular imaging was used in 4 procedures. Average time of procedure including right heart catheterization and BPA was 122±31 minutes (mean radiation dose 9374730 mGy) and average volume of contrast used was 268± 81mL per session.</p> <p>To examine the BPA procedure-related complications, all 57 sessions were reviewed. Procedure-related adverse events occurred in 24% of the interventions. Pulmonary artery (PA) vascular lesions were noted in 7 sessions (12%): 3 distal wire perforations and 4 dissections. Haemoptysis was noted in 5 sessions (9%). None of the patients with PA dissection showed need of transcatheter or surgical procedures. Balloon inflation was performed for 2 distal perforations, and 1 sealed without any intervention. We had 3 reperfusion edemas, all grade 2. None of the patients required oral intubation or mechanical ventilation at any time. Extra-pulmonary complications included 2 access site complications (hematoma and seroma). There was 1 contrast nephropathy KDIGO AKI staging 1. No patients had acute radiation-induced dermatitis. Importantly, there was no peri-procedural death.</p> <p><strong>Conclusions</strong>: In our initial experience, we show that BPA can be safely performed in patients with inoperable, residual or recurrent CTEPH, with 24% minor procedural-related complications but no major adverse event.</p>
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