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CAIC SPOTLIGHT: CONTROVERSIES IN CARDIOVASCULAR INTERVENTION

(P087) BALLOON PULMONARY ANGIOPLASTY AT A PULMONARY HYPERTENSION CENTRE OF EXCELLENCE: THE INITIAL CANADIAN EXPERIENCE

Thursday, October 24, 2024
9:45 AM – 10:45 AM PT
Location: 205-207

    Presenting Author(s)

  • AA

    Abdullah AlJohani, MBBS

    Cardiology Resident PGY4
    McGill University
    Montréal, Quebec, Canada

    • First Author(s)

  • AA

    Abdullah AlJohani, MBBS

    Cardiology Resident PGY4
    McGill University
    Montréal, Quebec, Canada

    • Supervisor(s)

  • AA

    Ali O. Abualsaud, MD

    Associate Professor of Medicine - Cardiologist
    McGill University
    McGill University
    Montreal, Quebec, Canada

    • Co-Author(s)

  • DL

    David Langleben, MD

    Senior Investigator, Lady Davis Institute Professor of Medicine, McGill University Director, Cardiol
    McGill University, Montréal, QC, Canada
    Montreal, Quebec, Canada

  • Andrew Hirsch, MD

    Devision of Respirology, Senior Investigator, Lady Davis Institute. Associate Professor
    montreal, Quebec, Canada

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by physical narrowing and occlusion of pulmonary arteries by organized thrombus, resulting in absent or reduced perfusion of downstream pulmonary vasculature. Balloon pulmonary angioplasty (BPA) is now a guideline-recommended therapeutic choice for CTEPH. We describe our single-center experience with BPA utilizing a retrospective review.

METHODS AND RESULTS: We identified 107 consecutive patients with CTEPH as suitable BPA candidates. They underwent 209 BPA sessions between June 2018 and February 2024. Baseline clinical, laboratory and hemodynamic measurements were obtained as well as immediate post procedural measurements. Assessment of WHO functional class, NTproBNP levels measurements were followed. Decision for further sessions was based on symptom improvement, procedural disease characteristics, and tolerance. PH therapy and anticoagulation was continued. Complications and rate were calculated and reported, namely, hypoxia and use of supplemental oxygen, hemoptysis, intubation, and death at 30 days post procedure.

Most patients have undergone 2 or more procedures (range 1-5). WHO functional class improved in most patients. None remained in FC IV and the majority were either in FC I or FC II. NTpro BNP decreased from 2022.64 ± 2710.92 to1038 ± 2155.51 (p-value < 0.001)
In terms of hemodynamics, mPAP has decreased from of 43.79±12.88 mmHg to 35.53 ± 12.57 (p-value < 0.001), PVR decreased from 632.07 ± 718.50 to 368.28 ± 265.26 (p-value < 0.001), while CI increased to 3.146 ± 0.765 from 2.743 ± 0.692 (p-value < 0.001). There was one procedure related death, and another patient died suddenly when she removed her oxygen at home. 9.6% of patients developed transient hemoptysis that resolved with treatment. None required intubation. Three (1.4%) cases incurred reperfusion edema.

Conclusion: BPA is shown to be a valid therapeutic option for patiens with symptomatic CTEPH.