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01. History of Cardiology
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07. Syncope and Bradycardia
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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Balloon pulmonary angioplasty 6 months results: short term performance of the new kid on the block for chronic thromboembolic pulmonary hypertension
Session:
Sessão de Comunicações Orais - Hipertensão Pulmonar e Congénitos
Speaker:
Ana Rita Pereira
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:
Ana Rita F. Pereira; Rita Calé; Filipa Ferreira; Maria José Loureiro; Débora Repolho; Daniel Sebaiti; Sofia Alegria; Sílvia Vitorino; Pedro Santos; Helder Pereira
Abstract
<p><strong>Introduction: </strong>Chronic thromboembolic pulmonary hypertension (CTEPH) had poor prognosis when treated only medically. Balloon pulmonary angioplasty (BPA) is emerging as an alternative therapy in patients (pts) with residual/recurrent pulmonary hypertension (PH) after pulmonary endarterectomy or inoperable disease. The aim of this study was to evaluate the short-term efficacy and safety of BPA programme.</p> <p><strong>Methods:</strong> Prospective single-centre study that included all BPA sessions performed from 2017 to 2019. Blood analyses, 6-minute walking test (6MWT) and right heart catheterization was performed at baseline and 6-months after the last session. </p> <p><strong>Results:</strong> From a total of 64 sessions, 57 were performed in CTEPH pts: 11 pts, mean age 65.8 ± 12.7 years, 72.7% female and 63.6% with inoperable disease. At baseline, all pts had functional capacity limitation (WHO functional class ≥ II), 72.6% were treated with pulmonary vasodilator therapy (including 2 pts under intravenous prostacyclin analogs) and 18.2% were under long-term oxygen therapy. The mean walked distance in 6MWT was 377.5 ± 66.1 meters, mean pulmonary arterial pressure (mPAP) was 33.0 ± 11.4 mmHg and pulmonary vascular resistance (PVR) 5.1 ± 3.8 uWood. Three pts (27.3%) presented severe haemodynamic disease (mPAP > 40 mmHg). The BPA programme was completed with a 6-months follow-up in 9 pts (81.8%): median of 4.5 sessions per patient with 4.0 ± 1.6 vessels dilated per session. A significant functional improvement was observed: all pts were in functional class I (p < 0.01) and the mean increase in 6 minute walked distance was 46.7 meters. There was also a trend for significant haemodynamic improvement with a 24.9% decrease in mPAP (p = 0.08) and a 43.6% decrease in PVR (p = 0.06). In the severe haemodynamic subgroup, the reduction was significant (figure 1): 50.9% in mPAP (p = 0.01) and 67.1% in PVR (p = 0.05). Intravenous prostacyclin analogs and long-term oxygen therapy were completed withdrawn. Minor complications were recorded in 24.6%. Pulmonary vascular lesions were the most common. No serious complications were reported.</p> <p><strong>Conclusions: </strong>This study confirms that a BPA strategy improves short-term symptoms, exercise capacity and haemodynamics with an acceptable risk-benefit ratio in pts with residual/recurrent PH after pulmonary endarterectomy or inoperable CTEPH. These data are in line with those published in the literature and encourage the development of the technique at a national level.</p>
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