Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension results of a multicenter registry

Aiko Ogawa, Toru Satoh, Tetsuya Fukuda, Koichiro Sugimura, Yoshihiro Fukumoto, Noriaki Emoto, Norikazu Yamada, Atsushi Yao, Motomi Ando, Hitoshi Ogino, Nobuhiro Tanabe, Ichizo Tsujino, Masayuki Hanaoka, Kenji Minatoya, Hiroshi Itoh, Hiromi Matsubara

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background-Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy-the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present study evaluated the safety and efficacy of BPA for chronic thromboembolic pulmonary hypertension based on a multicenter registry. Methods and Results-A total of 308 patients (62 men and 246 women; mean age, 61 years) underwent 1408 procedures at 7 institutions in Japan. Data were retrospectively reviewed to evaluate clinical outcome and complications. Hemodynamics were significantly improved in 249 patients in whom BPA was terminated, most often because of improvement in mean pulmonary arterial pressure or symptomatic improvement after 1154 procedures. In 196 patients who underwent followup right heart catheterization, improvement of hemodynamic parameters was maintained. Mean pulmonary arterial pressure decreased from 43.2±11.0 to 24.3±6.4 mm Hg after final BPA and 22.5±5.4 mm Hg at follow-up, with significant reduction of concomitant use of pulmonary hypertension-targeted therapy and oxygen supplementation. Complications occurred in 511 (36.3%), including pulmonary injury (17.8%), hemoptysis (14.0%), and pulmonary artery perforation (2.9%). Twelve patients (3.9%) died during follow-up, including 8 patients who died within 30 days after BPA. The leading causes of death were right heart failure, multiorgan failure, and sepsis. Overall survival was 96.8% (95% confidence interval, 93.7%-98.4%) at 1 and 2 years and 94.5% (95% confidence interval, 89.3%-97.3%) at 3 years, respectively, after the initial BPA procedure for all 308 patients. Conclusions-This multicenter registry suggested improved hemodynamic results after BPA. Complication rates were high, but overall survival was comparable with pulmonary endarterectomy. BPA may be an important therapeutic option in patients with chronic thromboembolic pulmonary hypertension.

Original languageEnglish
Article numbere004029
JournalCirculation: Cardiovascular Quality and Outcomes
Volume10
Issue number11
DOIs
Publication statusPublished - Jan 1 2017

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Balloon Angioplasty
Pulmonary Hypertension
Registries
Lung
Endarterectomy
Hemodynamics
Arterial Pressure
Confidence Intervals
Survival
Hemoptysis
Lung Injury
Cardiac Catheterization
Complementary Therapies
Pulmonary Artery
Cause of Death
Sepsis
Japan
Therapeutics
Heart Failure

Keywords

  • Angioplasty
  • Hypertension
  • Lung injury
  • Pulmonary
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension results of a multicenter registry. / Ogawa, Aiko; Satoh, Toru; Fukuda, Tetsuya; Sugimura, Koichiro; Fukumoto, Yoshihiro; Emoto, Noriaki; Yamada, Norikazu; Yao, Atsushi; Ando, Motomi; Ogino, Hitoshi; Tanabe, Nobuhiro; Tsujino, Ichizo; Hanaoka, Masayuki; Minatoya, Kenji; Itoh, Hiroshi; Matsubara, Hiromi.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 10, No. 11, e004029, 01.01.2017.

Research output: Contribution to journalArticle

Ogawa, A, Satoh, T, Fukuda, T, Sugimura, K, Fukumoto, Y, Emoto, N, Yamada, N, Yao, A, Ando, M, Ogino, H, Tanabe, N, Tsujino, I, Hanaoka, M, Minatoya, K, Itoh, H & Matsubara, H 2017, 'Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension results of a multicenter registry', Circulation: Cardiovascular Quality and Outcomes, vol. 10, no. 11, e004029. https://doi.org/10.1161/CIRCOUTCOMES.117.004029
Ogawa, Aiko ; Satoh, Toru ; Fukuda, Tetsuya ; Sugimura, Koichiro ; Fukumoto, Yoshihiro ; Emoto, Noriaki ; Yamada, Norikazu ; Yao, Atsushi ; Ando, Motomi ; Ogino, Hitoshi ; Tanabe, Nobuhiro ; Tsujino, Ichizo ; Hanaoka, Masayuki ; Minatoya, Kenji ; Itoh, Hiroshi ; Matsubara, Hiromi. / Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension results of a multicenter registry. In: Circulation: Cardiovascular Quality and Outcomes. 2017 ; Vol. 10, No. 11.
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AU - Satoh, Toru

AU - Fukuda, Tetsuya

AU - Sugimura, Koichiro

AU - Fukumoto, Yoshihiro

AU - Emoto, Noriaki

AU - Yamada, Norikazu

AU - Yao, Atsushi

AU - Ando, Motomi

AU - Ogino, Hitoshi

AU - Tanabe, Nobuhiro

AU - Tsujino, Ichizo

AU - Hanaoka, Masayuki

AU - Minatoya, Kenji

AU - Itoh, Hiroshi

AU - Matsubara, Hiromi

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N2 - Background-Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy-the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present study evaluated the safety and efficacy of BPA for chronic thromboembolic pulmonary hypertension based on a multicenter registry. Methods and Results-A total of 308 patients (62 men and 246 women; mean age, 61 years) underwent 1408 procedures at 7 institutions in Japan. Data were retrospectively reviewed to evaluate clinical outcome and complications. Hemodynamics were significantly improved in 249 patients in whom BPA was terminated, most often because of improvement in mean pulmonary arterial pressure or symptomatic improvement after 1154 procedures. In 196 patients who underwent followup right heart catheterization, improvement of hemodynamic parameters was maintained. Mean pulmonary arterial pressure decreased from 43.2±11.0 to 24.3±6.4 mm Hg after final BPA and 22.5±5.4 mm Hg at follow-up, with significant reduction of concomitant use of pulmonary hypertension-targeted therapy and oxygen supplementation. Complications occurred in 511 (36.3%), including pulmonary injury (17.8%), hemoptysis (14.0%), and pulmonary artery perforation (2.9%). Twelve patients (3.9%) died during follow-up, including 8 patients who died within 30 days after BPA. The leading causes of death were right heart failure, multiorgan failure, and sepsis. Overall survival was 96.8% (95% confidence interval, 93.7%-98.4%) at 1 and 2 years and 94.5% (95% confidence interval, 89.3%-97.3%) at 3 years, respectively, after the initial BPA procedure for all 308 patients. Conclusions-This multicenter registry suggested improved hemodynamic results after BPA. Complication rates were high, but overall survival was comparable with pulmonary endarterectomy. BPA may be an important therapeutic option in patients with chronic thromboembolic pulmonary hypertension.

AB - Background-Balloon pulmonary angioplasty (BPA) is an alternative therapy for patients with chronic thromboembolic pulmonary hypertension who are ineligible for pulmonary endarterectomy-the standard therapy. Currently, most reported results of BPA are from relatively small cohorts treated at single centers. The present study evaluated the safety and efficacy of BPA for chronic thromboembolic pulmonary hypertension based on a multicenter registry. Methods and Results-A total of 308 patients (62 men and 246 women; mean age, 61 years) underwent 1408 procedures at 7 institutions in Japan. Data were retrospectively reviewed to evaluate clinical outcome and complications. Hemodynamics were significantly improved in 249 patients in whom BPA was terminated, most often because of improvement in mean pulmonary arterial pressure or symptomatic improvement after 1154 procedures. In 196 patients who underwent followup right heart catheterization, improvement of hemodynamic parameters was maintained. Mean pulmonary arterial pressure decreased from 43.2±11.0 to 24.3±6.4 mm Hg after final BPA and 22.5±5.4 mm Hg at follow-up, with significant reduction of concomitant use of pulmonary hypertension-targeted therapy and oxygen supplementation. Complications occurred in 511 (36.3%), including pulmonary injury (17.8%), hemoptysis (14.0%), and pulmonary artery perforation (2.9%). Twelve patients (3.9%) died during follow-up, including 8 patients who died within 30 days after BPA. The leading causes of death were right heart failure, multiorgan failure, and sepsis. Overall survival was 96.8% (95% confidence interval, 93.7%-98.4%) at 1 and 2 years and 94.5% (95% confidence interval, 89.3%-97.3%) at 3 years, respectively, after the initial BPA procedure for all 308 patients. Conclusions-This multicenter registry suggested improved hemodynamic results after BPA. Complication rates were high, but overall survival was comparable with pulmonary endarterectomy. BPA may be an important therapeutic option in patients with chronic thromboembolic pulmonary hypertension.

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