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. 2023 Apr 24;16(8):976-983.
doi: 10.1016/j.jcin.2023.01.361. Epub 2023 Mar 22.

Periprocedural Complications With Balloon Pulmonary Angioplasty: Analysis of Global Studies

Nishant Jain  1 , Muhammad A Sheikh  2 , Divyansh Bajaj  3 , Whitney Townsend  4 , Richard Krasuski  5 , Eric Secemsky  6 , Saurav Chatterjee  7 , Victor Moles  8 , Prachi P Agarwal  9 , Jonathan Haft  10 , Scott H Visovatti  11 , Thomas M Cascino  8 , Kenneth Rosenfield  12 , Brahmajee K Nallamothu  13 , Vallerie V Mclaughlin  8 , Vikas Aggarwal  14
Affiliations

Periprocedural Complications With Balloon Pulmonary Angioplasty: Analysis of Global Studies

Nishant Jain et al. JACC Cardiovasc Interv. .

Abstract

Background: Balloon pulmonary angioplasty (BPA) was introduced as a treatment modality for patients with inoperable, medically refractory chronic thromboembolic pulmonary hypertension decades ago; however, reports of high rates of pulmonary vascular injury have led to considerable refinement in procedural technique.

Objectives: The authors sought to better understand the evolution of BPA procedure-related complications over time.

Methods: The authors conducted a systematic review of original articles published by pulmonary hypertension centers globally and performed a pooled cohort analysis of procedure-related outcomes with BPA.

Results: This systematic review identified 26 published articles from 18 countries worldwide from 2013 to 2022. A total of 1,714 patients underwent 7,561 total BPA procedures with an average follow up of 7.3 months. From the first period (2013-2017) to the second period (2018-2022), the cumulative incidence of hemoptysis/vascular injury decreased from 14.1% (474/3,351) to 7.7% (233/3,029) (P < 0.01); lung injury/reperfusion edema decreased from 11.3% (377/3,351) to 1.4% (57/3,943) (P < 0.01); invasive mechanical ventilation decreased from 0.7% (23/3,195) to 0.1% (4/3,062) (P < 0.01); and mortality decreased from 2.0% (13/636) to 0.8% (8/1,071) (P < 0.01).

Conclusions: Procedure-related complications with BPA, including hemoptysis/vascular injury, lung injury/reperfusion edema, mechanical ventilation, and death, were less common in the second period (2018-2022), compared with first period (2013-2017), likely from refinement in patient and lesion selection and procedural technique over time.

Keywords: balloon pulmonary angioplasty; chronic thromboembolic pulmonary hypertension; pulmonary artery angioplasty.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Krasuski has been a consultant to Actelion/Janssen Pharmaceuticals, Bayer Pharmaceuticals, Gore Medical and Medtronic; and has received research funding from the Adult Congenital Heart Association, Actelion, Corvia, CryoLife, Edwards Lifesciences, and Medtronic. Dr Rosenfield has been a consultant to or served on scientific advisory boards for Abbott Vascular, Althea Medical, Angiodynamics, Auxetics, Becton-Dickinson, Boston Scientific, Contego, Crossliner, Innova Vascular, Inspire MD, Janssen/Johnson and Johnson, Magneto, Mayo Clinic, MedAlliance, Neptune Medical, Penumbra, Philips, Surmodics, Terumo, Thrombolex, Truvic, Vasorum, and Vumedi; has received institutional research grants from the NIH, Abiomed, Boston Scientific, Novo Nordisk, Penumbra, and Gettinge-Atrium; has equity interest in Accolade, Access Vascular, Aerami, Althea Medical, Auxetics, Contego, Crossliner, Cruzar Systems, Embolitech, Endospan, Imperative Care/Truvic, Innova Vascular, InspireMD, JanaCare, Magneto, MedAlliance, Neptune Medical, Orchestra, PQ Bypass, Prosomnus, Shockwave, Skydance, Summa Therapeutics, Thrombolex, Valcare, Vasorum, and Vumedi; and is a board member and founder of the National PERT Consortium. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

FIGURE 1
FIGURE 1. Flow Diagram of the Search for Studies
Flow diagram of the search for studies included in the systematic review according to the preferred reporting items for systematic reviews and meta- analysis statement. See Table 1 for inclusion and exclusion criteria.
See this image and copyright information in PMC

Comment in

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