Hiroki Mizoguchi, Division of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan, and colleagues have refined balloon pulmonary angioplasty for the treatment of inoperable patients with chronic thromboemobolic pulmonary hypertension (CTEPH).
The study leader Hiromi Matsubara, Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama, Japan, commented on the study and said: “Recent progress in medical treatment for pulmonary arterial hypertension has improved the prognosis of the patients with the problem. However, patients with CTEPH have been left behind this progress. There have been no effective therapeutic options, especially for the patients diagnosed as unsuitable for pulmonary endarterectomy.”
Balloon pulmonary angioplasty for the treatment of CTEPH was first reported over 10 years ago therefore the authors aimed to readdress the procedure to maximise its clinical efficacy.
In the study, 68 patients with inoperable CTEPH were enrolled and underwent balloon pulmonary angioplasty. The patients were diagnosed as inoperable because of the location of the thrombi and surgical accessibility, age and comorbidities. All patients were in the World Health Organisation (WHO) functional class III or IV with high pulmonary arterial pressure.
Balloon pulmonary angioplasty procedure
According to the study, 68 patients underwent a total of 255 balloon pulmonary angioplasty sessions in which four (2–8) sessions were performed in each patient and the number of vessels dilated per session was three (1–14). The result of the balloon pulmonary angioplasty sessions was that one patient died after the third session because of right-sided heart failure and of the remaining 67 patients 64 (96%) were in the WHO functional class of I or II after the final session. Overall the mean pulmonary arterial pressure was significantly reduced (p<0.01) according to Mizoguchi and others.
Patients were followed up every six months after balloon pulmonary angioplasty. During follow-up one patient died of pneumonia and the remaining 66 patients are alive with 57 patients undergoing right heart catheterisation after final balloon pulmonary angioplasty. The authors reported that these patients had mean pulmonary arterial pressure of 24.0±5.8mmHg with maintained improved heamodynamics at 1±0.9 years.
The implications of the refined balloon pulmonary angioplasty as a treatment for inoperable CTEPH is that it adds to the weight of evidence which suggests it is an effective therapeutic option.
“With the refined technique, we could maximise the efficacy of balloon pulmonary angioplasty for inoperable patients with CTEPH without increasing complications. Improvements of haemodynamics and clinical function obtained by angioplasty were maintained for at least one year. Overall the outcome of angioplasty was almost comparable to that of endarterectomy,” said Matsubara. “Although there are remaining problems to be resolved such as the risk of reperfusion injury and the existence of a learning curve in performing the procedure, our results open up the prospect of pulmonary angioplasty as a promising therapeutic option for patients with CTEPH,” he added.
“Our refined balloon pulmonary angioplasty procedure improves clinical status and the haemodynamic of inoperable patients with CTEPH, with a low mortality,” concluded Mizoguchi et al.