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Balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: the UK experience.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Coghlan, John G 
Cannon, John E 
Taboada, Dolores 
Toshner, Mark 

Abstract

OBJECTIVE: Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) managed medically has a poor prognosis. Balloon pulmonary angioplasty (BPA) offers a new treatment for inoperable patients. The national BPA service for the UK opened in October 2015 and we now describe the treatment of our initial patient cohort. METHODS: Thirty consecutive, inoperable, anatomically suitable, symptomatic patients on stable medical therapy for CTEPH were identified and offered BPA. They initially underwent baseline investigations including Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) quality of life (QoL) questionnaire, cardiopulmonary exercise test, 6 min walk distance (6MWD), transthoracic echocardiography, N-terminal probrain natriuretic peptide (NT pro-BNP) and right heart catheterisation. Serial BPA sessions were then performed and after completion, the treatment effect was gauged by comparing the same investigations at 3 months follow-up. RESULTS: A median of 3 (IQR 1-6) BPA sessions per patient resulted in a significant improvement in functional status (WHO functional class ≥3: 24 vs 4, p<0.0001) and QoL (CAMPHOR symptom score: 8.7±5.4 vs 5.6±6.1, p=0.0005) with reductions in pulmonary pressures (mean pulmonary artery pressure: 44.7±11.0 vs 34.4±8.3 mm Hg, p<0.0001) and resistance (pulmonary vascular resistance: 663±281 vs 436±196 dyn.s.cm-5, p<0.0001). Exercise capacity improved (minute ventilation/carbon dioxide production: 55.3±12.2 vs 45.0±7.8, p=0.03 and 6MWD: 366±107 vs 440±94 m, p<0.0001) and there was reduction in right ventricular (RV) stretch (NT pro-BNP: 442 (IQR 168-1607) vs 202 (IQR 105-447) pg/mL, p<0.0001) and dimensions (mid RV diameter: 4.4±1.0 vs 3.8±0.7 cm, p=0.002). There were no deaths or life-threatening complications and the mild-moderate per-procedure complication rate was 10.5%. CONCLUSIONS: BPA is safe and improves the functional status, QoL, pulmonary haemodynamics and RV dimensions of patients with inoperable CTEPH.

Description

Keywords

Balloon pulmonary angioplasty, Chronic thromboembolic pulmonary hypertension, Right heart function, Aged, Angioplasty, Balloon, Arterial Pressure, Chronic Disease, Exercise Tolerance, Female, Humans, Hypertension, Pulmonary, Male, Middle Aged, Pulmonary Artery, Pulmonary Embolism, Recovery of Function, Time Factors, Treatment Outcome, United Kingdom, Vascular Resistance, Ventricular Function, Right, Ventricular Remodeling

Journal Title

Open Heart

Conference Name

Journal ISSN

2053-3624
2053-3624

Volume Title

7

Publisher

BMJ
Sponsorship
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)