Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: A Local Experience

In patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy (PEA) or have persistent pulmonary hypertension after surgery, balloon pulmonary angioplasty (BPA) has emerged as a viable treatment option. Data from South-east Asia (SEA) is lacking. We aim to share one of the first experiences with this treatment modality from the region.

All consecutive CTEPH patients who underwent BPA at our single tertiary cardiac institution from Jan 2016 were included. Baseline clinical characteristics and investigations as well as procedure details were collected. Efficacy outcomes included changes in functional class and pulmonary hemodynamics. Safety outcomes studied included peri-procedural complications and mortality.

A total of 32 BPA sessions were performed for 8 patients (mean age 59.3±18.6 years; 3 males; average 4 BPA sessions per patient (range 2 to 7)). The average number of pulmonary segments treated per session was 7.1±3.0. There were 5 CTEPH patients who completed BPA, 1 patient with ongoing treatment and 2 patients who had BPA for persistent pulmonary hypertension after PEA (See Table 1). The procedural success rate was 100%. There were 2 (6%) cases of haemoptysis from distal wire perforation that required gel foam distal embolization. These cases were stable after overnight monitoring in the high dependency. No other complications were noted - there were no mortalities, intubations or requirements for advanced cardiac life support systems. There was significant improvement in New York Heart Association (NYHA) functional class at 3 to 6 months (p=0.012), and this improvement persisted at 1 to 2 years of follow-up (p=0.026). There was also significant reduction in pulmonary vascular resistance from 6.8±2.6 Woods pre-treatment to 3.9±2.6 Woods (p=0.040) post-treatment and a trend towards reduction in mean pulmonary artery pressure from 42±10mmHg to 33±11mmHg post-treatment (p=0.102).

In suitable CTEPH patients ineligible for PEA, BPA is a safe and efficacious treatment modality.