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Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: who benefits the most?
Session:
Posters (Sessão 3 - Écran 7) - Intervenção Coronária e Estrutural 1 - Vários
Speaker:
Rita Calé
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Rita Calé; Filipa Ferreira; Ana Rita Pereira; Sofia Alegria; Mariana Martinho; Débora Repolho; Pedro Santos; Sílvia Vitorino; Maria José Loureiro; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>Balloon pulmonary angioplasty (BPA) is an alternative therapy in patients (pts) with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual/recurrent pulmonary hypertension (PH) after surgery. It is unclear who are the best candidates for this technique. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong> Prospective single-centre study that included all CTEPH pts submitted to BPA from 2017 to 2020. Efficacy and safety of BPA were compared in two groups: those with severe hemodynamics meaning mean pulmonary artery pressure (mPAP) above 40 mmHg before the first session of BPA (Group S; 5 patients; 34 procedures) and a group with less severe hemodynamics (Group L; 6 patients, 31 procedures). Clinical assessment including WHO functional class, plasma biomarkers, 6-minute walking test (6MWT) and right heart catheterization were performed at baseline and 6-months after the last BPA session. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> Pts in group S were more severe at the baseline: 100% under pulmonary vasodilator therapy with a median of 3 drugs vs 83.3% under a median of 1 drug (p=0.061); 80% on long-term oxygen therapy vs 0 (p=0.015) and more severe WHO functional class (I/II/III/IV: 0/1/4/0 vs. 0/6/0/0, p=0.015). There was a slight increase in the number of BPA sessions per pt (6.8±0.8 vs 5.2±1.5, p=0.056) and in the number of treated segments in group S (11.6±2.2 vs 10.0±1.0, p=0.085). The magnitude of clinical benefit of BPA is significantly higher in group S with more decrease in mPAP, pulmonary vascular resistance and NT-proBNP and more improvement in 6MWT (Figure 1). However, there was no significant difference in WHO functional class at follow-up between groups (I/II/III/IV: 4/1/0/0 in group S vs. 6/0/0/0 in group L, p=0.455). Minor complications occurred in 25%, and lung injury in 3.1% of the procedures, with no differences between groups. No pts required mechanical ventilation or extracorporeal membrane oxygenation, and there were no procedural deaths. With a mean follow-up of 36±12 months, there was one non-cardiovascular death in group L.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions: </strong>The magnitude of clinical benefit of BPA is significantly higher in more severe pts, without further complications. However, functional class improve in both groups, suggesting that in pts with less severely impaired hemodynamics, the efficacy of BPA should probably not be measured in terms of hemodynamics at rest, but rather by exercise parameters such as cardiopulmonary exercise testing or even exercise right heart catheterization.</span></span></span></p>
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