BPA effective for residual pulmonary hypertension, but carries higher burden of complications

Balloon pulmonary angioplasty (BPA) seems to be an effective intervention against residual pulmonary hypertension (PH) after pulmonary endarterectomy (PEA), but comes with a high risk of haemoptysis, a recent study has found.

Researchers retrospectively assessed 25 patients (mean age 62.5±13.4 years, 64.0 percent women) with residual PH after PEA. In total, all patients received 101 sessions of BPA. A comparator group of 21 patients with chronic thromboembolic pulmonary hypertension (CTEPH), treated with BPA alone, was also included.

Compared to those treated with BPA alone, patients who received BPA for residual PH showed no significant difference in terms of clinical outcomes. Laboratory findings, including levels of haemoglobin and brain natriuretic peptide, as well as the need for supportive therapies like warfarin and direct oral anticoagulants, were all comparable between groups.

The same was true for the parameters of right heart catheterization, except for cardiac index, which was significantly lowered in patients who had undergone BPA after PEA (p=0.005).

Nevertheless, symptoms, exercise capacity, and haemodynamic parameters were generally similar between groups.

However, in terms of procedural complications, severe haemoptysis occurred more frequently in patients undergoing BPA after PEA (16.8 percent vs 5.6 percent; p=0.016).

“To the best of our knowledge, this is the first study to directly compare the outcomes and complications of BPA after PEA versus BPA alone,” the researchers said. “The results revealed that BPA was effective for improving clinical and haemodynamic parameters in cases of residual PH after PEA.”

“However, BPA had a higher complication rate when it was used to treat residual PH after PEA,” they added.