Predictors of procedural complications in balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

Background: Balloon pulmonary angioplasty (BPA) is an effective treatment for inoperable chronic thromboem-bolic pulmonary hypertension, with good results reported for residual pulmonary hypertension (PH) after pul-monary endarterectomy (PEA). However, BPA is associated with complications, such as pulmonary artery perforation and vascular injury, which can lead to critical pulmonary hemorrhage requiring embolization and mechanical ventilation. Furthermore, the risk factors for occurrence of complications in BPA are unclear; there-fore, this study aimed to evaluate predictors of procedural complications in BPA.Methods: In this retrospective study, we collected clinical data (patient characteristics, details of medical therapy, hemodynamic parameters, and details of the BPA procedure) from 321 consecutive sessions involving 81 pa-tients who underwent BPA. Procedural complications were evaluated as endpoints.Results: BPA for residual PH after PEA was performed in 141 sessions (43.9 %), which involved 37 patients. Pro-cedural complications were observed in 79 sessions (24.6 %), including severe pulmonary hemorrhage requiring embolization in 29 sessions (9.0 % of all sessions). No patients experienced severe complications requiring intu-bation with mechanical ventilation or extracorporeal membrane oxygenation. Age >= 75 years and mean pulmo-nary artery pressure >= 30 mmHg were independent predictors of procedural complications. Residual PH after PEA was a significant predictor of severe pulmonary hemorrhage requiring embolization (adjusted odds ratio, 3.048; 95 % confidence interval, 1.042-8.914, p = 0.042).Conclusions: Older age, high pulmonary artery pressure, and residual PH after PEA increase the risk of severe pul-monary hemorrhage requiring embolization in BPA.(c) 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.