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A German single centre two-years experience of pulmonary balloon angioplasty in patients with chronic thromboembolic pulmonary hypertension

Session CTEPH: Catheter-directed and surgical therapy

Speaker Christoph Liebetrau

Event : ESC Congress 2017

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Pulmonary Hypertension
  • Session type : Moderated Posters

Authors : C Liebetrau (Bad Nauheim,DE), CBW Wiedenroth (Bad Nauheim,DE), AB Breithecker (Bad Nauheim,DE), MH Haas (Bad Nauheim,DE), RH Huetz (Bad Nauheim,DE), HAG Ghofrani (Bad Nauheim,DE), SG Guth (Bad Nauheim,DE), CWH Hamm (Bad Nauheim,DE), EM Mayer (Bad Nauheim,DE)

C. Liebetrau1 , C.B.W. Wiedenroth2 , A.B. Breithecker1 , M.H. Haas3 , R.H. Huetz3 , H.A.G. Ghofrani1 , S.G. Guth2 , C.W.H. Hamm3 , E.M. Mayer2 , 1Kerckhoff Heart and Thorax Center - Bad Nauheim - Germany , 2Kerckhoff Heart and Thorax Center, Thoracic Surgery - Bad Nauheim - Germany , 3Kerckhoff Heart and Thorax Center, Department of Cardiology - Bad Nauheim - Germany ,

Chronic pulmonary hypertension

European Heart Journal ( 2017 ) 38 ( Supplement ), 834

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) can be treated curatively by pulmonary endarterectomy (PEA). However, up to 1/3 of all CTEPH patients are not operable. Balloon pulmonary angioplasty (BPA) is an emerging treatment for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), but less is known about the persistent procedural success of BPA.

Purpose: Evaluating BPA success in in-operable CTEPH patients during mid-term follow-up.

Methods: Between March 2014 and October 2016 consecutive patients (n=553) with CTEPH were investigated for treatment options (PEA, BPA, medical therapy) by an interdisciplinary team, consisting of thoracic surgeons, interventional cardiologists, radiologists and pneumologists. All patients underwent right- and left heart-catheterization, pulmonalis angiography, 6-minute-walk, echocardiography, spiroergometry and CT-scan. Out of 153 (27.7%) patients who were classified as inoperable 102 patients were planned for BPA as staged procedure. All BPAs (n=293) were performed via femoral approach. NT-proBNP was measured in all patients before every single BPA and after 6 months follow-up.

Results: All patients (age 64.7±13.5 yrs) were at WHO functional class III with elevated systolic RV pressure (68.2±14.7 mmHg) at baseline. Almost half (46.2%) of the patients had been previously treated medically for pulmonary hypertension. After completion of BPA treatment (mean 5.1 (SD 1.5) procedures) in 52 patients the mean pulmonary artery pressure was significantly decreased (37.0 [IQR 25.5–44.0] mmHg vs. 30.0 [IQR 19.5–35.5] mmHg; P<0.0001). We could observe an substantial NT-proBNP decrease (1120.0 ng/L [IQR 215.2–1969.0] vs. 352.0 ng/L [IQR 115.4–1074.0]; P<0.0001). Patients (n=6) without significant mPAP decrease did not show NT-proBNP decrease either (1548 ng/L [IQR 876–2236] vs. 1485 ng/L [IQR 698–2023]; P=0.67). Looking for patients (n=29) with completed BPA treatment and 6 months follow-up the persistent mPAP decrease was still significant compared with with the mPAP prior to the first BPA (36.5 [25.0–44.5] mmHg vs. 30.5 [25.0–39.8] mmHg; P=0.001). NT-proBNP decreased further after 6 months follow-up indicating further right ventricular remodeling (450 ng/L [IQR 182–1327] vs. 175 ng/L [IQR 104–539]; P=0.003). During BPA we observed 6 dissections of a segment artery, which was treated conservatively. Five patients developed reperfusion oedema with the need for non-invasive ventilation. During 18 procedures patients developed hemoptysis. One patient died two weeks after hospital discharge suffering from hematothorax. After BPA 80% of the patients showed improved WHO functional class (P<0.05) and prolonged 6 minute walk (P<0.05).

Conclusion: BPA is a valuable treatment option with low periprocedural risk for patients with inoperable CTEPH showing persistent success during mid-term follow-up. NT-proBNP might be helpful to estimate the procedural success.

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