SPC365

Balloon pulmonary angioplasty in CTEPH – Ready for the frontline?

Session: Sessão de Posters 02 - Embolia Pulmonar
Speaker: Sofia Esteves

Congress: CPC 2024
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: Cartazes
FP Number: ---
Authors: Sofia Esteves; Miguel Azaredo Raposo; Daniel Inácio Cazeiro; Tatiana Guimarãres; Susana Robalo Martins; Nuno Lousada; Rui Plácido; Miguel Nobre Menezes; Cláudia Moreira Jorge; Fausto J. Pinto

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Balloon pulmonary angioplasty (BPA) is currently guideline recommended as a treatment option when pulmonary endarterectomy (PEA) is not feasible, and medical therapy does not ameliorate symptoms. There are now reports supporting BPA as a 1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> line option, even in patients (pts) with operable disease, excluding pts with large central clots.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To evaluate hemodynamic, laboratorial, and clinical results from a BPA program in a PH referral center, comparing pts who had BPA only with those with prior PEA.&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Retrospective single center study, analyzing a population of CTEPH pts treated in a PH referral center, enrolled in a BPA program. Clinical parameters with risk stratification (with the 4 strata risk assessment tool), right heart catheterization (RHC), echocardiography, laboratorial data and clinical outcomes were assessed. We compared the results from BPA sessions between groups, regarding hemodynamic changes and complications.&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We analyzed a population of 18 pts with a mean age of 64&plusmn;11,5 years, 78% female, with a mean FUP was of 6.8&plusmn;2years. Regarding therapeutic strategy, 67% of pts were enrolled in a BPA program due to residual PH post PEA, and 33% of pts had first line BPA, being deemed not suitable for surgery.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">All pts were under vasodilator specific therapy, 50% under dual therapy and 17% with triple.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">67 BPA sessions were performed, with a mean of 4 sessions/pt and 3 lesions treated/session. Hemoptysis was the only complication, occurring in 9 sessions, resolving with non-invasive ventilation.</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><s>&nbsp;</s></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Hemodynamic outcomes after BPA sessions: there was a significant difference between groups, with larger reductions in the BPA only group. Mean reduction of mPAP was 6,8&plusmn;12,4 mmHg (17,3 in BPA vs 2,9 in BPA post PEA); mean reduction of sPAP was 10,2&plusmn; 18,2 mmHg (21 vs 6,12); median reduction of PVR was 0.83 IQR 3,5 Wu (3,7 vs no reduction).&nbsp; These results were mainly driven by 4 pts in the PEA+BPA group, who displayed worsening hemodynamics despite optimized medical therapy and successive BPA sessions.&nbsp; 3 patients died, 2 of which were of this progressively worsening cohort. At FUP, 70% of pts were at low or intermediate low risk status, 44% having improved WHO functional class.&nbsp; Median reduction of NTproBNP was of 1450&plusmn;2340 pg/ml.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">BPA is a safe</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><s> </s></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">when conducted in experienced centers. CTEPH has a complex physiopathology and the benefits of BPA extend beyond hemodynamic improvement measured by RHC. Pts with residual PH post PEA tend to have less significant hemodynamic improvement, probably reflecting the complexity of the lesions and the associated microvasculopathy. In selected pts, BPA as an alternative to PEA, should be explored in adequately powered studies.&nbsp;</span></span></span></p>

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