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Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: safety and procedural tolerance in elderly patients
Session:
Sessão de Posters 01 - Intervenção não valvular
Speaker:
Mariana Martinho
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Martinho; Rita Cale; Filipa Ferreira; Sofia Alegria; Débora Repolho; Bárbara Marques Ferreira; João Mirinha Luz; Silvia Vitorino; Pedro Santos; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="background-color:#fcfcfc"><span style="color:black">Introduction: </span></span></span></strong><span style="font-size:11.0pt"><span style="color:black">Balloon pulmonary angioplasty (BPA) represents an emerging therapeutic approach for chronic thromboembolic disease, with and without pulmonary hypertension (CTEPH and CTED). Nevertheless, it is a complex procedure, and with some risks that may be less well tolerated in older and frailer patients (pts).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Purpose:</span></strong> <span style="font-size:11.0pt"><span style="color:black">We aimed to determine the prevalence of complications and the rate of premature discontinuation of BPA program in pts aged <u>></u>75 years, and compare it with younger pts.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Methods</span></span></strong><span style="font-size:11.0pt"><span style="color:black">: Detailed procedural and technical aspects were collected for consecutive pts with inoperable or residual/recurrent CTEPH and CTED, undergoing BPA at a single institution from 2017-2023. Procedural complications were classified as the 6th World Symposium on Pulmonary Hypertension. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results:</span></strong><span style="font-size:11.0pt"><span style="color:black"> A total of 129 BPA sessions in 28pts were performed. Among these, 8 were aged <u>></u> 75 years (mean age 80.4±3.8 years; 75.0% women; 100% CTEPH). There were no differences in the severity of pulmonary haemodynamics between groups: mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) before the first BPA session were 36.8±10.4mmHg and 5.3±2.5WU in elderly and 34.0±12.8mmHg and 4.9±3.0WU in the control group, respectively (p>0.05). Femoral access was used for all pts. The mean number of vessels treated per procedure were 3.7±2.2 in elderly versus 4.5±1.8 in younger (p>0.05). BPA was interrupted before achieving complete treatment in 4 elderly pts (50.0%): 2 due to inability to tolerate the duration and prolonged immobilization of the procedure and 2 due to procedure complications. The average time of fluoroscopy was 56.1±14.2minutes and the average volume of contrast used was 256.5± 73.5mL per session. Procedure-related adverse events occurred in 19.4% of the interventions (36.0% in elderly vs 15.4% in younger pts, OR 3.09, 95%CI 1.17-8.20, p=0.023, table 1). Pulmonary artery (PA) vascular injury was noted in 7 BPA lesions (5.4% per procedure and 1.3% per vessel): hemoptysis in all, but perforation was only detected angiographically in 6 of them, 3 requiring embolization). We had 6 lung injuries, all grade 2. No pts experienced severe complications requiring mechanical ventilation, extracorporeal membrane oxygenation or peri-procedural death. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Conclusions</span></span></strong><span style="font-size:11.0pt"><span style="color:black">: BPA seems to be a safe procedure, without fatal or severe complications. However, elderly pts had a 3.1-fold increased risk of mild complications and a higher probability of interrupting the program before achieving complete treatment of all amenable lesions.</span></span></span></span></span></p>
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