Abstract 13474: Balloon Pulmonary Angioplasty Improves Clinical Status and Hemodynamics in Patients With Non-operable Chronic Thromboembolic Pulmonary Hypertension in Comparison to Pulmonary Endarterectomy in Operable Patients
Backgrounds: Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by stenosis and obstruction of pulmonary artery with non-resolving organized thromboemboli, and the prognosis is poor without treatment. Pulmonary endarterectomy (PEA) is the gold standard for the treatment of CTEPH, and the only curative therapy; however, up to 40% of CTEPH patients are considered non-operable due to distal thromboembolism or comorbidities. Recently, for non-operable CTEPH patients, the efficacy of balloon pulmonary angioplasty (BPA) is noted with refining the procedures and perioperative management. We examined the efficacy and safety of BPA in comparison to PEA.
Methods: We treated 46 CTEPH patients from November 2001 to May 2013. Operable 21 patients underwent PEA (mean age; 56.8 ± 14.7 years old, 7 males and 14 females, 4 patients with vasodilator therapy), and 25 non-operable CTEPH patients were performed BPA from March 2011 to May 2013 (67.8 ± 10.3 years old, 7 males and 18 females, 20 patients with vasodilator therapy). We analyzed pre and post-operative hemodynamics and complications in each procedures.
Results: PEA significantly improved hemodynamics in operable patients (Table). Although in non-operable patients, vasodilator therapy could not significantly improved symptoms and hemodynamics (mean PAP; 37.4 ± 7.5 to 39.1 ± 7.7 mmHg, PVR; 737 ± 324 to 700 ± 261 dyn·s/cm5, CI; 2.19 ± 0.43 to 2.33 ± 0.49 L/min/m2), BPA significantly improved these indices as observed in PEA for operable patients (Table). Reperfusion pulmonary injury occurred in 23.8 % of PEA group and 70.3 % of BPA group, which did not lead to mortality events. Mortality rate of PEA group and BPA group were 9.5% and 4% respectively.
Conclusions: BPA could improve the clinical status and hemodynamics in non-operable CTEPH patients as effectively and safely as PEA in operable patients. We may be able to treat most CTEPH patients with PEA or BPA.
- Pulmonary hypertension
- Pulmonary circulation
- Interventional cardiology
- Cardiac surgery
- Pulmonary embolism
- © 2013 by American Heart Association, Inc.