State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Respir Res. 2022 May 7;23(1):117. doi: 10.1186/s12931-022-02017-6.
To evaluate the safety and efficacy of bilateral balloon pulmonary angioplasty (BPA) as compared with unilateral BPA for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH).
We reviewed 210 consecutive BPA sessions for 92 CTEPH patients, including 124 unilateral BPA sessions and 86 bilateral BPA sessions. Radiation exposure, operation details, lesions characteristics and the occurrence of complications were compared between unilateral BPA and bilateral BPA. 131 BPA sessions with a hemodynamics follow-up were included for efficacy analysis, in which hemodynamics changes were compared. Logistic regression analysis was used to identify factors associated with the occurrence of complications.
Bilateral BPA treated more lobes, arteries and lesions [3 (2, 4) vs. 2 (1, 3) lobes, p < 0.001; 8 (5.5, 10) vs. 6 (4, 8) vessels, p = 0.003; 9 (7, 12) vs. 8 (5, 10) lesions, p = 0.01] in one single session than unilateral BPA in a comparable operation duration and amount of contrast media given. Overall, the occurrence of complications was similar between bilateral BPA and unilateral BPA [9 (10.5%) vs. 12 (9.7%), p = 0.83]. Hemodynamics effects didn't differ significantly between bilateral BPA and unilateral BPA in a single session [mPAP, - 4.5 ± 8.6 vs. - 3.6 ± 7.3 mmHg, p = 0.52; PVR, - 1.1 (- 3.5, 0.8) vs. - 1.8 (- 5.2, 0.3) Wood units, p = 0.21]. For the initial BPA session, bilateral BPA also treated more lobes, arteries and lesions than unilateral BPA [3 (2, 4) vs. 2 (1, 2) lobes, p < 0.001; 8.0 (5.8, 9.3) vs. 6.0 (4.0, 8.0) vessels, p = 0.04; 9 (6, 12) vs. 7 (4, 10) lesions, p = 0.02]. The occurrence of complications was also similar [5 (13.2%) vs. 5 (9.3%), p = 0.80], even in patients with poor baseline hemodynamics. Univariate regression analysis reveals the number of lobes treated/session, but not bilateral BPA, as predictive factors of complications.
Bilateral BPA may be safely and effectively performed in patients with CTEPH without increasing operation duration and radiation burden, even in patients with unfavorable baseline hemodynamics.
评估双侧球囊肺动脉成形术（BPA）与单侧 BPA 治疗不能手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者的安全性和疗效。
我们回顾了 92 例 CTEPH 患者的 210 次 BPA 治疗，包括 124 次单侧 BPA 和 86 次双侧 BPA。比较单侧 BPA 和双侧 BPA 的辐射暴露、手术细节、病变特征和并发症发生情况。对 131 次有血流动力学随访的 BPA 进行疗效分析，比较血流动力学变化。采用 logistic 回归分析识别与并发症发生相关的因素。
双侧 BPA 在单次手术中治疗了更多的肺叶、动脉和病变[3（2，4）比 2（1，3）个肺叶，p<0.001；8（5.5，10）比 6（4，8）条血管，p=0.003；9（7，12）比 8（5，10）个病变，p=0.01]，而手术时间和造影剂用量相当。总的来说，双侧 BPA 和单侧 BPA 的并发症发生率相似[9（10.5%）比 12（9.7%），p=0.83]。单次手术中，双侧 BPA 和单侧 BPA 的血流动力学效果无显著差异[mPAP，-4.5±8.6 比-3.6±7.3mmHg，p=0.52；PVR，-1.1（-3.5，0.8）比-1.8（-5.2，0.3）Wood 单位，p=0.21]。对于初始 BPA 治疗，双侧 BPA 也治疗了更多的肺叶、动脉和病变[3（2，4）比 2（1，2）个肺叶，p<0.001；8.0（5.8，9.3）比 6.0（4.0，8.0）条血管，p=0.04；9（6，12）比 7（4，10）个病变，p=0.02]。并发症发生率也相似[5（13.2%）比 5（9.3%），p=0.80]，甚至在基线血流动力学较差的患者中也是如此。单变量回归分析显示，治疗的肺叶数/次，而不是双侧 BPA，是并发症的预测因素。
双侧 BPA 可安全有效地用于 CTEPH 患者，不增加手术时间和辐射负担，即使在基线血流动力学不佳的患者中也是如此。
