Long-Term Outcomes After Percutaneous Transluminal Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension
Authors: Takumi Inami, Masaharu Kataoka, Ryoji Yanagisawa, Haruhisa Ishiguro, Nobuhiko Shimura, Keiichi Fukuda, Hideaki Yoshino, Toru Satoh
Journal: Circulation (2016)

T herapeutic options for patients with chronic thromboembolic pulmonary hypertension (CTEPH) have expanded significantly with the development of catheter-based interventional therapy, namely percutaneous transluminal pulmonary angioplasty (PTPA) or so-called balloon pulmonary angioplasty (BPA).Conventionally, surgical pulmonary endarterectomy has been the first-line treatment for operable CTEPH.Several teams, including our own, have developed PTPA procedures, and some important reports have been published. 1-4Extrapolating from the published papers, about one third of patients with confirmed CTEPH in Japan have been treated with PTPA over the past decade.It is important to note that according to updated guidelines for the diagnosis and treatment of pulmonary hypertension published in 2016 by the European Society of Cardiology and the European Respiratory Society, 5 this catheter-based therapy has been accepted as a therapeutic strategy (Class IIb recommendation for patients with technically inoperable disease or with unfavorable risk-to-benefit ratio for surgery).Because PTPA has only recently been developed, long-term outcomes have not been reported thus far.Therefore, the purpose of the present observational study was to clarify the long-term outcomes for PTPA.The performance of PTPA and analysis of clinical data in the present study were approved by the institutional review boards of Kyorin University Hospital, and all patients provided written informed consent.Over the past 7 years (from April 2009 to July 2016), 649 consecutive PTPA sessions were performed at Kyorin University Hospital (Japan) in 170 patients with CTEPH (male/female, 37/133) whose median age was 66 years (25th and 75th percentiles, 55 and 73 years).The indications and procedures for PTPA have been described previously. 1,2The median number of sessions per patient was 4 (25th and 75th percentiles, 2 and 4), and the median number of treated vessels per patient was 15 (25th and 75th percentiles, 10 and 20).During the median observation period of 2.8 years (25th and 75th percentiles, 1.2 and 4.1 years), 4 patients died after PTPA (1 each as a result of cancer, pneumonia, sepsis, and multiorgan failure related to pulmonary artery injury as a complication of the PTPA procedure), indicating 1-, 3-, and 5-year survival (all cause) of 98.7% (95% confidence interval [CI], 94.9-99.7),98.0% (95% CI, 93.7-99.3),and 95.5% (95% CI, 85.9-98.6),respectively.Hemodynamic changes over time were analyzed at short-term (0.5-1.5 years), midterm (1.5-3.5 years), and long-term (>3.5 years; Figure ) follow-up intervals.Because follow-up hemodynamic assessment was not protocolized, some patients had no subsequent assessments, and others had assessments in 1, 2, or all 3 of the intervals analyzed; therefore, analyses are reported for each interval hemodynamic assessment in the context of the baseline values of that subset of patients.Hemodynamic data on mean pulmonary arterial pressure and pulmonary vascular resistance revealed that the therapeutic efficacy of PTPA was maintained long term.It is important to note that although mean pulmonary arterial pressure was maintained almost within the normal range for the long term after PTPA,