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Effectiveness and safety of balloon pulmonary angioplasty in a small cohort of CTEPH patients
Session:
Sessão de Comunicações Orais - Hipertensão Pulmonar e Congénitos
Speaker:
Rafael Pacheco dos Santos
Congress:
CPC 2020
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:
Rafael Santos; Claudia Jorge; Miguel Nobre Menezes; Rui Plácido; Tatiana Guimarães; Nuno Lousada; Inês Aguiar Ricardo; Joana Rigueira; Tiago Graça Rodrigues; Nelson P. Cunha; Afonso Nunes Ferreira; Pedro Silvério António; Sara Couto Pereira; Pedro Morais; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p><strong>Introduction:</strong> Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and potentially life-threatening disease. Balloon pulmonary angioplasty (BPA) is an emerging procedure to treat CTEPH patients who are not candidates to surgery - pulmonary thromboendarterectomy (PTE) - or still have residual pulmonary hypertension and remain symptomatic after PTE.</p> <p><strong>Objective:</strong> to evaluate the early results of a BPA program at a pulmonary hypertension referral center and its impact on the pulmonary hemodynamics parameters and NT-proBNP value.</p> <p><strong>Methods:</strong> we performed a prospective single center study of patients who were submitted to BPA since May 2018 until November 2019 and in whom after repeated sessions a decrease in mean pulmonary arterial pressure (PAPm) bellow 30 mmHg was achieved. Demographic, clinical, laboratorial (NT-proBNP), pulmonary hemodynamic data (right-sided heart catheterization), procedure characteristics and complications were analyzed. For statistical analysis, the Wilcoxon test was used.</p> <p><strong>Results:</strong> During this period, 8 patients were submitted to BPA and met criteria for complete revascularization. The median age was 73 years (IQ 65-75,5), with just 1 male patient. The median number of sessions was 4 (minimum 2, maximum 7). All of the patients were on specific vasodilator therapy and receiving anticoagulation (5 with warfarin and 3 with a NOAC) and three patients were on oxygen therapy. Half of the patients had a previous history of PTE (the median time between surgery and BPA was 24,5 months).</p> <p>Mild hemoptysis was the only complication - 5 (14%) events in a total of 36 sessions. Short duration noninvasive ventilation with CPAP was performed with resolution. No cases of reperfusion injury were reported.</p> <p>Regarding the pulmonary hemodynamics status, a clear decrease in PAPm was observed, from 40 mmHg (IQ36,5-46,5) before BPA to 26 mmHg (IQ21,25-28,5) after BPA (p= 0,012) and in vascular pulmonary resistance - 5,6 WU (IQ4,42-11,21) before BPA vs 3,45 WU (IQ3,2-4,43) after BPA (p= 0,046). There were no significant changes in cardiac output.</p> <p>It was also found a statistically significant decrease in NT-proBNP – 550 ng/L (IQ 208,5-1801) before BPA vs 313 ng/L (IQ 162,75-845,25) after BPA (p= 0,025).</p> <p><strong>Conclusion:</strong> Although our cohort is small, BPA has proven to be a safe procedure, with a few complications of mild degree and with a significant improvement in pulmonary hemodynamics parameters and NT-proBNP values, which is in agreement with the existing literature.</p> <p> </p>
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