Jain Nishant, Sheikh Muhammad A, Bajaj Divyansh, Townsend Whitney, Krasuski Richard, Secemsky Eric, Chatterjee Saurav, Moles Victor, Agarwal Prachi P, Haft Jonathan, Visovatti Scott H, Cascino Thomas M, Rosenfield Kenneth, Nallamothu Brahmajee K, Mclaughlin Vallerie V, Aggarwal Vikas
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
JACC Cardiovasc Interv. 2023 Apr 24;16(8):976-983. doi: 10.1016/j.jcin.2023.01.361. Epub 2023 Mar 22.
Balloon pulmonary angioplasty (BPA) was introduced as a treatment modality for patients with inoperable, medically refractory chronic thromboembolic pulmonary hypertension decades ago; however, reports of high rates of pulmonary vascular injury have led to considerable refinement in procedural technique.
The authors sought to better understand the evolution of BPA procedure-related complications over time.
The authors conducted a systematic review of original articles published by pulmonary hypertension centers globally and performed a pooled cohort analysis of procedure-related outcomes with BPA.
This systematic review identified 26 published articles from 18 countries worldwide from 2013 to 2022. A total of 1,714 patients underwent 7,561 total BPA procedures with an average follow up of 7.3 months. From the first period (2013-2017) to the second period (2018-2022), the cumulative incidence of hemoptysis/vascular injury decreased from 14.1% (474/3,351) to 7.7% (233/3,029) (P < 0.01); lung injury/reperfusion edema decreased from 11.3% (377/3,351) to 1.4% (57/3,943) (P < 0.01); invasive mechanical ventilation decreased from 0.7% (23/3,195) to 0.1% (4/3,062) (P < 0.01); and mortality decreased from 2.0% (13/636) to 0.8% (8/1,071) (P < 0.01).
Procedure-related complications with BPA, including hemoptysis/vascular injury, lung injury/reperfusion edema, mechanical ventilation, and death, were less common in the second period (2018-2022), compared with first period (2013-2017), likely from refinement in patient and lesion selection and procedural technique over time.
数十年前，球囊肺动脉血管成形术（BPA）被引入作为无法手术、药物治疗无效的慢性血栓栓塞性肺动脉高压患者的一种治疗方式；然而，关于肺血管损伤高发生率的报告促使手术技术有了相当大的改进。
作者试图更好地了解BPA手术相关并发症随时间的演变情况。
作者对全球肺动脉高压中心发表的原始文章进行了系统综述，并对BPA手术相关结局进行了汇总队列分析。
该系统综述确定了2013年至2022年来自全球18个国家的26篇已发表文章。共有1714例患者接受了总计7561次BPA手术，平均随访7.3个月。从第一阶段（2013 - 2017年）到第二阶段（2018 - 2022年），咯血/血管损伤的累积发生率从14.1%（474/3351）降至7.7%（233/3029）（P < 0.01）；肺损伤/再灌注水肿从11.3%（377/3351）降至1.4%（57/3943）（P < 0.01）；有创机械通气从0.7%（23/3195）降至0.1%（4/3062）（P < 0.01）；死亡率从2.0%（13/636）降至0.8%（8/1071）（P < 0.01）。
与第一阶段（2013 - 2017年）相比，第二阶段（2018 - 2022年）BPA手术相关并发症，包括咯血/血管损伤、肺损伤/再灌注水肿、机械通气和死亡，不太常见，这可能是由于随着时间推移患者和病变选择以及手术技术得到了改进。
