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Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: a multicentre registry

EuroIntervention 2022;17:1104-1111. DOI: 10.4244/EIJ-D-21-00230

1. Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Warsaw, Poland; 2. Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland; 3. Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, Centre for Rare Cardiovascular Diseases, John Paul II Hospital in Krakow, Krakow, Poland; 4. 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland; 5. Department of Cardiology, Provincial Specialist Hospital Research and Development Center, Wrocław, Poland; 6. Clinic of Cardiology, Pomeranian Medical University, Szczecin, Poland; 7. 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland; 8. 1st Department of Cardiology, Silesian Medical University, Upper Silesian Medical Centre, Katowice, Poland; 9. Department of Cardiology, Medical University of Warsaw, Warsaw, Poland; 10. Department of Radiography, Medical University of Lublin, Lublin, Poland; 11. Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; 12. Clinic of Cardiac Transplantation and Mechanical Circulatory Support, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; 13. Department of Cardiac Surgery, Medicover Hospital, Warsaw, Poland

Background: Balloon pulmonary angioplasty (BPA) is a promising therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy.

Aims: The present study aimed to evaluate the safety and efficacy of BPA for CTEPH using the first multicentre registry of a single European country.

Methods: Data were obtained from the Database of Pulmonary Hypertension in the Polish Population (NCT03959748), a prospective, multicentre registry of adult and paediatric pulmonary arterial hypertension (PAH) and CTEPH, for a total of 236 patients with confirmed CTEPH (124 women; mean age 67 years) who underwent 1,056 BPA procedures at eight institutions in Poland.

Results: In 156 patients who underwent follow-up assessments after a median of 5.9 (IQR: 3.0-8.0) months after final BPA, the mean pulmonary arterial pressure decreased from 45.1±10.7 to 30.2±10.2 mmHg (p<0.001) and pulmonary vascular resistance from 642±341 to 324±183 dynes (p<0.001), and the six-minute walking test (6MWT) improved from 341±129 to 423±136 m (p<0.001). Pulmonary injury related to the BPA procedure occurred in 6.4% of all sessions. Eighteen patients (7.6%) died during follow-up, including 4 (1.7%) who died within 30 days after BPA. Overall survival was 92.4% (95% confidence interval [CI]: 87.6%-94.9%) three years after the initial BPA procedure.

Conclusions: This multicentre registry confirmed significant improvement of haemodynamic, functional, and biochemical parameters after BPA. Complication rates were low and overall survival comparable to the results of another registry. Therefore, BPA may be an important therapeutic option in patients with CTEPH in Poland.

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