Balloon pulmonary angioplasty for the treatment of residual or recurrent pulmonary hypertension after pulmonary endarterectomy

Background: Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). However, persistent pulmonary hypertension continues in 5-35% of patients after PEA. Recently, balloon pulmonary angioplasty (BPA) showed promise as a strategy for patients with non-operable CTEPH. Therefore, we investigated the usefulness of BPA for residual pulmonary hypertension after PEA. Methods: Fifteen patients with residual pulmonary hypertension after PEA received 71 BPA sessions (4.7 +/- 1.4 sessions/patient). Themean time between the PEA and the first BPA sessionwas 28.1 +/- 25.8months. All patients underwent a comprehensive diagnosticwork-up, including right heart catheterization, functional and laboratory tests, before, and 6-4 weeks after the BPA sessions. Results: After BPA, the mean pulmonary arterial pressure decreased from 44.7 +/- 6.4 to 30.8 +/- 7.5 mm Hg (31% decline; p < 0.001). Pulmonary vascular resistance decreased from 551.9 +/- 185.2 to 343.8 +/- 123.8 dyn* s/cm(-5) (38% decline; p < 0.001). The 6-min walking distance increased from383 +/- 104 to 476 +/- 107m(mean change +93m; p < 0.001). In two sessions (2.8%), serious periprocedural complications occurred. During amean follow-up of 18 +/- 14.3 months, one patient died two months after the last BPA session. Fourteen patients survived. Conclusions: BPA could be a promising therapeutic strategy for persistent pulmonary hypertension after PEA in patients with CTEPH. (c) 2018 Elsevier B.V. All rights reserved.