Balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: short- and long-term results

Background: Data on the short-term efficacy and safety of balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) are widely presented in the world literature; meanwhile information on long-term patient outcomes is very limited. Objective: The study aimed at the assessing of the short- and long-term results of balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension who completed all BPA sessions. Methods: We conducted a retrospective data analysis on 144 patients with a diagnosis of CTEPH who have completed BPA series in the common center from August 2015 through April 2023. Clinical and procedural results including the data from right heart catheterization, as well as long-term outcomes were collected and evaluated. Nonparametric rank sum tests were used to assess changes in hemodynamic parameters of the pulmonary artery before and after BPA. Survival analysis was performed using the Kaplan-Meier method: the impact of individual and procedure-related factors on the occurrence of death in the long-term follow-up period was assessed with univariate and multivariate logistic regressions. Results: A total of 446 BPA sessions were performed across 144 patients. The median value of mean pulmonary artery pressure (mPAP) decreased significantly by 9 mmHg (from 41 to 32). Out of 446 BPA sessions, there were 4 periprocedural deaths (0.9% of the number of procedures and 2.7% of the number of patients). Of the 134 patients available for contact, 26 (19.4%) died in the long-term period. Overall, 1- and 3- year survival probabilities were 93% and 82%, respectively. Multivariable logistic regression analysis showed that the chronic obstructive pulmonary disease (OR: 7.8 (1.86, 36.7), p = 0.006), coronary artery disease (OR: 3.78 (1.28, 11.2), p = 0.02) and a smaller decrease of mPAP after last BPA (OR: 0.91 (0.86, 0.97), p = 0.003) were independently associated with a death at follow-up period. Additional receiver operating characteristic (ROC) analysis revealed that a change in mPAP by 4.5 mmHg was the most effective predictor of death at follow-up with sensitivity and specificity equal to 0.68 and 0.60, respectively. Conclusion: Balloon pulmonary angioplasty in patients with CTEPH is a safe procedure with significant enhancement of pulmonary hemodynamics but long-term results remain still unsatisfactory that emphasizes the complexity of this cohort of patients and the demand for developing algorithms for their treatment and monitoring.