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. 2024 Jan-Dec:18:17534666241232521.
doi: 10.1177/17534666241232521.

Optimal short-term outcomes in balloon pulmonary angioplasty: the minimum frequency of three sessions annually

Affiliations

Optimal short-term outcomes in balloon pulmonary angioplasty: the minimum frequency of three sessions annually

Xin Li et al. Ther Adv Respir Dis. 2024 Jan-Dec.

Abstract

Background: Balloon pulmonary angioplasty (BPA) is typically performed in a sequential manner.

Objectives: This study aimed to determine the lowest frequency of BPA for patients who could not reach treatment goals in a short period.

Design: Retrospective cohort.

Methods: We retrospectively enrolled 186 BPA-treated patients diagnosed with chronic thromboembolic pulmonary hypertension. According to the accumulative number of performed BPA sessions or treated pulmonary vessels or the ratio of the number of treated pulmonary vessels/the number of baseline lesions (T/P) prior to the initial occurrence of clinical outcome or censored date, we divided patients into different groups. The principal outcome was clinical worsening.

Results: After stratifying patients by the number of performed BPA sessions, most baseline parameters were comparable among groups. During follow-up, 31 (16.7%) of 186 patients experienced clinical worsening. The 6-month cumulative clinical worsening-free survival rates of ⩾2 performed sessions group were significantly higher than that of 1 performed session group. The 12-month cumulative rates of clinical worsening-free survival exhibited a declining pattern in the subsequent sequence: ⩾3, 2, and 1 performed BPA sessions, and this trend persisted when follow-up time exceeded 12 months. The 6-, 12-, and 24-month cumulative clinical worsening-free survival rates were comparable between patients with 3 and ⩾4 performed BPA sessions. Similar results were also observed when stratifying patients by the accumulative number of treated pulmonary vessels (⩽8, 9-16, ⩾17) and T/P (⩽0.789, 0.790-1.263, ⩾1.264).

Conclusion: To achieve optimal short-term outcomes, patients might need to undergo ⩾2 BPA sessions or have ⩾9 pulmonary vessels treated or have T/P ⩾0.790 within 6 months, and undergo ⩾3 BPA sessions or have ⩾17 pulmonary vessels treated or have T/P ⩾1.264 within 12 months.

Keywords: chronic thromboembolic pulmonary hypertension; interventional therapy; pulmonary hypertension; right heart failure.

Plain language summary

The least number of BPA session to reach a favorable outcomeWhy was the study done? Balloon pulmonary angioplasty (BPA) has been recommended for patients with chronic thromboembolic pulmonary hypertension, which can significantly improve patients’ hemodynamics. However, BPA is typically performed in a stepwise manner, and the duration from the initial session to the final session could extend over a year. If patients could not quickly undergo adequate number of BPA sessions and reach hemodynamic target due to various reasons, what is the best frequency of BPA for them? What did the researchers do? We retrospectively enrolled 186 BPA-treated patients diagnosed with chronic thromboembolic pulmonary hypertension. According to the accumulative number of BPA sessions, we divided patients into different groups to identify the best frequency of BPA to improve prognosis. What did the researchers find? Patients who received at least two BPA sessions within six months had significantly better prognosis than those with one BPA session. Patients who received at least three BPA sessions within a year had significantly better prognosis than those with two BPA sessions. What do the findings mean? To achieve optimal short-term outcome, patients might need to undergo at least two BPA sessions within six months, and undergo at least three BPA sessions within a year.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curves based on the number of performed BPA sessions. (a) The main analysis included all patients. (b) Sensitivity analysis included patients with at least 12-month follow-up data. (c) Explanatory analysis of 6-month clinical worsening-free rates. (d) Explanatory analysis of 12-month clinical worsening-free rates. Please refer to Supplemental Materials for a high-resolution version using the zoom-in function. BPA, balloon pulmonary angioplasty.
Figure 2.
Figure 2.
Kaplan–Meier survival curves based on the number of treated pulmonary vessels. (a) The main analysis included all patients. (b) Sensitivity analysis included patients with at least 12-month follow-up data. (c) Explanatory analysis of 6-month clinical worsening-free rates. (d) Explanatory analysis of 12-month clinical worsening-free rates. Please refer to Supplemental Materials for a high-resolution version using the zoom-in function.
Figure 3.
Figure 3.
Kaplan–Meier survival curves based on the ratio of the number of treated pulmonary vessels/number of baseline lesions. (a) The main analysis included all patients. (b) Sensitivity analysis included patients with at least 12-month follow-up data. (c) Explanatory analysis of 6-month clinical worsening-free rates. (d) Explanatory analysis of 12-month clinical worsening-free rates. Please refer to Supplemental Materials for a high-resolution version using the zoom-in function.
Figure 4.
Figure 4.
Subgroup analysis of Kaplan–Meier survival curves between patients with 3 and ⩾4 performed BPA sessions. It yielded similar results between patients with 17 and 24 and ⩾25 treated pulmonary vessels, or patients with T/P = 1.264–1.912 and ⩾1.913 (Supplemental Figure S3). (a) The main analysis included all patients. (b) Sensitivity analysis included patients with at least 12-month follow-up data. (c) Explanatory analysis of 6-month clinical worsening-free rates in patients with at least 6-month follow-up. (d) Explanatory analysis of 12-month clinical worsening-free rates in patients with at least 12-month follow-up. Please refer to Supplemental Materials for a high-resolution version using the zoom-in function.
Figure 5.
Figure 5.
Patient-level analysis of complications, stratified by the number of performed BPA sessions. It yielded similar results when stratifying patients by the number of treated pulmonary vessels or the ratio of the number of treated pulmonary vessels/the number of baseline lesions (Supplemental Figure S4). Please refer to Supplemental Materials for a high-resolution version using the zoom-in function. BPA, balloon pulmonary angioplasty.

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