Pulmonary Circulation Centre, Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital in Krakow, Poland; Centre for Innovative Medical Education, Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland.
Clinic of Cardiac Transplantation and Mechanical Circulatory Support, Department of Heart Diseases, Wroclaw Medical University, Poland.
Int J Cardiol. 2022 Aug 15;361:71-76. doi: 10.1016/j.ijcard.2022.05.029. Epub 2022 May 14.
Balloon pulmonary angioplasty (BPA) has become a therapeutic option for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Despite significant improvement in the technique, treatment of subtotal (STO) and total (TO) pulmonary artery occlusions with BPA may pose risk, but the efficacy is less known.
We aimed to evaluate the safety and efficacy of BPA in STO/TO.
We included consecutive patients with inoperable CTEPH, who underwent BPA treatment. To evaluate the efficacy and safety we grouped all BPA sessions into these in which recanalization of at least one STO or TO was performed and into those without. The primary efficacy outcome was a decrease of pulmonary vascular resistance (PVR) after BPA sessions with STO/TO recanalization as compared to those without.
We analysed 169 BPA sessions in 50 CTEPH patients. Out of a total number of 831 lesions subjected for BPA, 169 were classified as STOs or TOs [123 (15,6%) and 39 (4,7%) respectively]. At least one STO/TO recanalization was successfully performed during 90 BPA sessions. Three (2,3%) STOs and 8 (20,5%) TOs were not recanalized despite repeated attempts. Recanalization of at least one STO/TO at the level of segmental pulmonary artery was associated with a significant PVR improvement as compared to subsegmental-only STO/TO recanalizations or no recanalizations (-126 ± 192 vs -38 ± 135 dyn·s·cm - 5, p = 0.007). The rate of complications was similar in STO/TO and non-STO/TO lesions (4.1% vs 2.4%, p = 0.22).
The use of BPA for the recanalization of subtotal and total PA occlusions is safe and feasible. Recanalization of segmental occlusive lesions leads to a significant improvement in PVR as compared to dilatation of nonocclusive ones.
球囊肺动脉成形术（BPA）已成为治疗无法手术的慢性血栓栓塞性肺动脉高压（CTEPH）的一种治疗选择。尽管该技术有了显著的改进，但用 BPA 治疗次全（STO）和全（TO）肺动脉闭塞可能存在风险，但疗效知之甚少。
我们旨在评估 BPA 在 STO/TO 中的安全性和疗效。
我们纳入了连续接受 BPA 治疗的无法手术的 CTEPH 患者。为了评估疗效和安全性，我们将所有 BPA 治疗分为至少一条 STO 或 TO 再通的治疗和未再通的治疗。主要疗效终点是 STO/TO 再通的 BPA 治疗与未再通的 BPA 治疗相比，肺血管阻力（PVR）下降。
我们分析了 50 例 CTEPH 患者的 169 次 BPA 治疗。在总共接受 BPA 的 831 个病变中，169 个被归类为 STO 或 TO[123（15.6%）和 39（4.7%）]。在 90 次 BPA 治疗中，至少有一条 STO/TO 成功再通。尽管反复尝试，仍有 3 个（2.3%）STO 和 8 个（20.5%）TO 未再通。与亚段 STO/TO 再通或无再通相比，节段性肺动脉至少一条 STO/TO 再通与显著的 PVR 改善相关（-126±192 与-38±135 dyn·s·cm-5，p=0.007）。STO/TO 与非 STO/TO 病变的并发症发生率相似（4.1%与 2.4%，p=0.22）。
BPA 用于再通次全和全肺动脉闭塞是安全可行的。与非闭塞性扩张相比，节段性闭塞性病变的再通可显著改善 PVR。
