Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Curr Opin Pulm Med. 2022 Sep 1;28(5):369-374. doi: 10.1097/MCP.0000000000000898.
To provide an update on balloon pulmonary angioplasty (BPA) for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH), a pulmonary vascular disease that is characterized by fibro-thrombotic material mechanically obliterating major pulmonary arteries, resulting in increased pulmonary vascular resistance (PVR), progressive pulmonary hypertension (PH) combined with a microscopic pulmonary vasculopathy [1▪▪], right ventricular (RV) failure [2] and premature death.
Data from a most recent CTEPH European registry (2015 and 2016) suggest significantly improved survival [3▪] of CTEPH patients compared with survival in the eighties [4], or with data from 2007 and 2009 [5]. Pulmonary endarterectomy (PEA) is still the gold-standard therapy for CTEPH [6,7]. However, only around two thirds of all CTEPH patients are amenable to surgery [3▪,5]. Patients not suitable for PEA and treated conservatively have a poor prognosis [8]. BPA may have a role for this particular group of patients. [9-11]. Currently, BPA programs are available in many countries, with excellent results at expert centers [12-15,16▪,17,18▪▪]. Based on recent data, BPA seems to have a greater impact on symptomatic and hemodynamic improvement than medical therapy with riociguat alone [15].
The evidence favoring BPA is growing, but there is still a lack of published controlled trials. In addition, treatment concepts including indication, technical performance, use of PH-targeted medication, and the concept of follow-up vary between centers. In addition, there is a significant learning curve impacting outcomes [13]. The data from the International BPA registry will provide answers for some of the open questions.
介绍球囊肺动脉成形术（BPA）治疗慢性血栓栓塞性肺动脉高压（CTEPH）的最新进展。CTEPH 是一种以纤维血栓性物质机械性阻塞大肺动脉为特征的肺血管疾病，导致肺血管阻力（PVR）增加、进行性肺动脉高压（PH）合并显微镜下肺血管病变[1▪▪]、右心室（RV）衰竭[2]和过早死亡。
最近一项 CTEPH 欧洲登记处（2015 年和 2016 年）的数据表明，与 80 年代相比[4]，或与 2007 年和 2009 年的数据相比[5]，CTEPH 患者的生存率显著提高[3▪]。肺动脉内膜切除术（PEA）仍然是 CTEPH 的金标准治疗方法[6,7]。然而，只有大约三分之二的 CTEPH 患者适合手术[3▪,5]。不适合 PEA 且保守治疗的患者预后较差[8]。BPA 可能对这组特定患者有作用[9-11]。目前，许多国家都开展了 BPA 项目，在专家中心取得了良好的效果[12-15,16▪,17,18▪▪]。基于最近的数据，BPA 似乎比单独使用 riociguat 的药物治疗在改善症状和血液动力学方面有更大的影响[15]。
支持 BPA 的证据越来越多，但仍缺乏发表的对照试验。此外，治疗概念包括适应证、技术性能、PH 靶向药物的使用以及随访概念在不同中心之间存在差异。此外，还存在显著的学习曲线影响结果[13]。国际 BPA 登记处的数据将为一些悬而未决的问题提供答案。
