SPC365

COMPLICATIONS OF BALLOON PULMONARY ANGIOPLASTY FOR CHRONIC THROMBOEMBOLIC PULMONARY DISEASE ACCORDING THE CLASSIFICATION PROPOSED BY THE 6TH WORLD SYMPOSIUM ON PULMONARY HYPERTENSION

Session: CO 19- Hipertensão Pulmonar
Speaker: Ana Rita Pereira

Congress: CPC 2021
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; Sofia Alegria; Débora Repolho; Pedro Santos; Sílvia Vitorino; Mariana Martinho; Daniel Sebaiti; Maria José Loureiro; Hélder Pereira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri"><strong><span style="background-color:#fcfcfc"><span style="color:black">Introduction: </span></span></strong><span style="color:black">Balloon pulmonary angioplasty</span> <span style="color:black">(BPA) </span><span style="color:black">is a complex procedure and not risk free.</span><strong> </strong><span style="color:black">In an attempt to standardize reports of </span><span style="color:black">BPA</span> <span style="color:black">complications in the several centers, a classification of complications was proposed by the task force on </span><span style="color:black">chronic thromboembolic hypertension (</span><span style="color:black">CTEPH) in the 6<sup>th</sup> World Symposium on Pulmonary Hypertension (WSPH). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri"><strong>Purpose:</strong> <span style="color:black">To determine the prevalence of BPA complications according to the classification of 6<sup>th</sup> WSPH and to identify its predictors.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri"><strong><span style="color:black">Methods</span></strong><span style="color:black">: Detailed procedural and technical aspects were collected for consecutive patients (pts) with inoperable, residual/recurrent chronic thromboembolic disease, undergoing BPA at</span><span style="background-color:white"><span style="color:#333333"> a single </span></span><span style="color:black">institution from December/2017 to December/2020. Per procedure logistic regression analysis was used to evaluate the predictive variables for complications.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri"><strong><span style="color:black">Results:</span></strong><span style="color:black"> A total of 76 BPA sessions in 15 pts were performed (mean age 63.2&plusmn;14.0 years; 60.0% women; 86.7% CTEPH). Mean pulmonary artery pressure and pulmonary vascular resistance before the first BPA session were 33.1&plusmn;13.3 mmHg and 4.8&plusmn;3.2 woods unit, respectively (73.3% of pts under vasodilator therapy). Femoral access was used for all pts. Mean vessels treated per procedure were 4.3&plusmn;1.9 (324 vessels in total). Webs, subtotal occlusions, ring-like stenosis and total occlusions were noted in 215 (66.4%), 58 (17.9%), 31 (9.6%) and 20 (6.2%) treated vessels, respectively. We performed 21 pressure-wire-guided sessions (27.6%). Intravascular imaging was used in 6 procedures (7.9%). Average time of fluoroscopy was 60.3&plusmn;14.0 minutes and volume of contrast 273.0&plusmn;73.0 mL per session. Procedure-related adverse events occurred in 25.0% of the interventions (27.6% in the first two years vs 16.7% in the last two). Pulmonary artery vascular injuries were noted in 6 BPA vessels (7.9% per procedure and 1.9% per treated vessel): haemoptysis in all, but perforation was only detected angiographically in 3 of them (balloon inflation was performed for 2 distal perforations, and 1 perforation sealed without any intervention). Vascular dissection in distal lesions occurred in 4 cases (5.3%) with no need of transcatheter or surgical procedures. We had 3 lung injuries, all grade 2. None of the pts required oral intubation or mechanical ventilation. Extra-pulmonary complications were illustrated in table. Importantly, there was no peri-procedural death. The occurrence of vascular or lung injuries was 0% in pressure-wire-guided BPA versus 14.5% in non-guided (p=0.098). Multivariate analysis revealed that age (OR 1.05; CI 1.01-1.10; p=0.030) was the only independent predictor of complications.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri"><strong><span style="color:black">Conclusions</span></strong><span style="color:black">: In our experience, BPA can be safely performed in inoperable, residual or recurrent CTEPH or CTED pts, with 25% minor procedural-related complications but no major adverse event. Age </span><span style="color:black">was the strongest factor related to the occurrence of complications.</span></span></span></p>