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Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: 5 years of experience in a Portuguese pulmonary hypertension referral center
Session:
Comunicações Orais - Sessão 10 - Hipertensão Pulmonar Tromboembólica Crónica
Speaker:
Rita Calé
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Calé; Filipa Ferreira; Sofia Alegria; Débora Repolho; Ana Rita Pereira; Mariana Martinho; Sílvia Vitorino; Pedro Santos; 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 establish alternative therapy in chronic thromboembolic pulmonary hypertension (CTEPH) patients (pts) with residual pulmonary hypertension (PH) after pulmonary endarterectomy (PEA) or inoperable disease. The aim of this study was to evaluate the effectiveness and safety of BPA in the first 5 years of experience in a Portuguese PH referral center.</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 BPA sessions performed in CTEPH pts from 12/2017 to 12/2022. Clinical assessment including WHO functional class, plasma biomarkers, Doppler echocardiogram, 6 minutes walking test (6MWT) and right heart catheterization was performed at baseline, 6-months and >3 years after the last session. Life-threatening complications related with the procedure were defined as death in the first 30 days, need of invasive ventilation or circulatory support. Major complications were vascular complications requiring surgical or percutaneous intervention or contrast nephropathy requiring dialysis. Lung injury and hemoptysis was also assessed.</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> A total of 103 sessions were performed in 21 CTEPH pts (mean age <span style="color:black">64.6±14.8 years, 66.7% female): 15 inoperable and 6 with residual PH after PEA. 14 pts completed the program (median of 5.5 sessions per pt; mean of 24.8</span><span style="color:black">±</span><span style="color:black">8.1 vessels treated per pt). At baseline, 85.7% were treated with pulmonary vasodilator therapy (including 5 pts under intravenous prostacyclin analogs) and 35.7% (5 pts) were under long-term oxygen therapy. At 6-months follow-up (Table 1), there were significant improvements in WHO functional class, 6MWT, right ventricular function and hemodynamic: 25.7% decrease in mean pulmonary artery pressure (p=0.016) and 42.1% decrease in pulmonary vascular resistance (p=0.012). Prostacyclin analogs and long-term oxygen therapy were withdrawn in 4 pts. Vascular lesions occurred in 8 sessions (7.8%): but only 3 pulmonary artery perforation required percutaneous treatment (prolonged balloon inflation). Hemoptysis occurred in 6 sessions (5.8%) and lung injury occurred in 6 sessions (5.8%, all grade 2). There was 4.9% contrast nephropathy, with no need of dialysis. There were no life-</span>threatening complications. <span style="color:black">After a mean follow-up of 42.5</span><span style="color:black">±17 months, survival was 92.9% (one pt died of malignancy 28 months after beginning BPA). </span> </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>This study confirmed the safety and effectiveness of BPA in residual PH after surgery or inoperable CTEPH. These data encourage the development of the technique at a national level.</span></span></span></p>
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