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Pulmonary vascular disease
Original research
Balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension: the UK experience
  1. Stephen P Hoole1,
  2. John G Coghlan2,
  3. John E Cannon3,
  4. Dolores Taboada3,
  5. Mark Toshner3,
  6. Karen Sheares3,
  7. Andrew John Fletcher1,
  8. Guillermo Martinez4,
  9. Alessandro Ruggiero5,
  10. Nicholas Screaton5,
  11. David Jenkins6 and
  12. Joanna Pepke-Zaba3
  1. 1Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  2. 2Department of Cardiology, Royal Free Hospital, London, United Kingdom
  3. 3Pulmonary Vascular Disease Unit, Royal Papworth Hospital NHS foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  4. 4Department of Anaesthetics, Royal Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  5. 5Department of Radiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  6. 6Department of Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
  1. Correspondence to Dr Stephen P Hoole; steve.hoole{at}doctors.org.uk

Abstract

Objective Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) managed medically has a poor prognosis. Balloon pulmonary angioplasty (BPA) offers a new treatment for inoperable patients. The national BPA service for the UK opened in October 2015 and we now describe the treatment of our initial patient cohort.

Methods Thirty consecutive, inoperable, anatomically suitable, symptomatic patients on stable medical therapy for CTEPH were identified and offered BPA. They initially underwent baseline investigations including Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) quality of life (QoL) questionnaire, cardiopulmonary exercise test, 6 min walk distance (6MWD), transthoracic echocardiography, N-terminal probrain natriuretic peptide (NT pro-BNP) and right heart catheterisation. Serial BPA sessions were then performed and after completion, the treatment effect was gauged by comparing the same investigations at 3 months follow-up.

Results A median of 3 (IQR 1–6) BPA sessions per patient resulted in a significant improvement in functional status (WHO functional class ≥3: 24 vs 4, p<0.0001) and QoL (CAMPHOR symptom score: 8.7±5.4 vs 5.6±6.1, p=0.0005) with reductions in pulmonary pressures (mean pulmonary artery pressure: 44.7±11.0 vs 34.4±8.3 mm Hg, p<0.0001) and resistance (pulmonary vascular resistance: 663±281 vs 436±196 dyn.s.cm-5, p<0.0001). Exercise capacity improved (minute ventilation/carbon dioxide production: 55.3±12.2 vs 45.0±7.8, p=0.03 and 6MWD: 366±107 vs 440±94 m, p<0.0001) and there was reduction in right ventricular (RV) stretch (NT pro-BNP: 442 (IQR 168–1607) vs 202 (IQR 105–447) pg/mL, p<0.0001) and dimensions (mid RV diameter: 4.4±1.0 vs 3.8±0.7 cm, p=0.002). There were no deaths or life-threatening complications and the mild-moderate per-procedure complication rate was 10.5%.

Conclusions BPA is safe and improves the functional status, QoL, pulmonary haemodynamics and RV dimensions of patients with inoperable CTEPH.

  • Balloon pulmonary angioplasty
  • Chronic thromboembolic pulmonary hypertension
  • Right heart function
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2019-001144

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    Footnotes

    • Contributors All authors have contributed to this manuscript and have read and agreed to its submission for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.