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Comparative Study
. 2025 Aug 6;25(1):376.
doi: 10.1186/s12890-025-03741-7.

Difference in efficacy between pulmonary endarterectomy and balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Kenichi Yanaka  1 , Kazuhiko Nakayama  2   3 , Yu Taniguchi  1 , Hiroyuki Onishi  1 , Yoichiro Matsuoka  1 , Hidekazu Nakai  4 , Kenji Okada  4 , Toshiro Shinke  1   5 , Noriaki Emoto  1   6 , Ken-Ichi Hirata  1
Affiliations
Comparative Study

Difference in efficacy between pulmonary endarterectomy and balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Kenichi Yanaka et al. BMC Pulm Med. .

Abstract

Background: Both pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) can be considered for the invasive treatment of chronic thromboembolic pulmonary hypertension (CTEPH). However, the technique applied to treat pulmonary vessels differs between PEA and BPA. While PEA removes lesions with thickened intima and organized thrombus, BPA improves pulmonary arterial flow by dilating stenosis and obstruction without removing the lesions. There have been limited reports on the differential efficacy between PEA and BPA. This study aimed to compare the baseline characteristics and efficacy of both treatments in CTEPH.

Methods: Between November 2001 and May 2019, 55 patients underwent PEA and 77 had only BPA performed. We evaluated clinical parameters before performing PEA and BPA, and on follow-up.

Results: The patients who underwent BPA were older and had fewer proximal lesions and milder pulmonary hemodynamics compared with those who underwent PEA (mean pulmonary arterial pressure: 34.0 ± 8.6 vs. 43.0 ± 9.9 mm Hg, p < 0.001). Although both groups showed improvement in most of their clinical data, cardiac index was not improved by BPA as opposed to PEA (2.5 ± 0.6 to 2.5 ± 0.6 L/min/m2, p = 0.99, 2.0 ± 0.6 to 2.6 ± 0.8 L/min/m2, p < 0.001, respectively). Furthermore, RC (resistance-compliance) time was significantly decreased by PEA (0.54 ± 0.16 to 0.45 ± 0.12 s, p < 0.001), but unchanged by BPA (0.54 ± 0.16 to 0.51 ± 0.13 s, p = 0.21).

Conclusions: BPA did not change RC time and cardiac index, while PEA reduced RC time and improved cardiac index. The technical approach of removing intra-vascular organized thrombi and thickened intima by PEA could have a more profound impact on pulmonary circulation and cardiac function improvements compared with BPA.

Keywords: Balloon pulmonary angioplasty; Chronic thromboembolic pulmonary hypertension; Pulmonary arterial compliance; Pulmonary circulation; Pulmonary endarterectomy; Pulmonary vascular resistance; Resistance-compliance time.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The present study was approved by the Ethics Committee of Kobe University (approval No. B190027). All enrolled patients were offered the option to opt out if they did not wish to participate. The written informed consent was waived because of the retrospective design. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
Extraction of study subjects. BPA indicates balloon pulmonary angioplasty; CTEPH, chronic thromboembolic pulmonary hypertension; PEA, pulmonary endarterectomy
Fig. 2
Fig. 2
Changes in clinical parameters after PEA and BPA. Comparison of clinical parameters before and after PEA and BPA. (A) NYHA, (B) Cardiac index and (C) RC time. Bars represent standard deviation. BPA indicates balloon pulmonary angioplasty; NYHA, New York Heart Association functional classification; PEA, pulmonary endarterectomy
Fig. 3
Fig. 3
Changes in pulmonary vascular resistance-compliance relationship after PEA and BPA. A and B indicates PVR-PAC relationship in pre and post-PEA, respectively. D and E, in pre and post-BPA, respectively. C shows comparison of average RC time (PVR x PAC) in pre and post-PEA; F, in pre and post BPA. There was a significant difference between pre and post-PEA in RC time but not between pre and post-BPA. Values are mean ± standard deviation. BPA indicates balloon pulmonary angioplasty; PAC, pulmonary arterial compliance; PEA, pulmonary endarterectomy, PVR, pulmonary vascular resistance
Fig. 4
Fig. 4
Change in RC time by PEA and BPA according to CTEPH type. Values are mean ± standard deviation. BPA indicates balloon pulmonary angioplasty; CTEPH, chronic thromboembolic pulmonary hypertension; PEA, pulmonary endarterectomy
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