Establishing a Balloon Pulmonary Angioplasty Program for Chronic Thromboembolic Pulmonary Hypertension: A United States Single-Center Experience

Introduction: Balloon pulmonary angioplasty (BPA) is a less invasive treatment alternative for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are unable to move forward with pulmonary thromboendarterectomy. This report describes a single-center experience with a nascent BPA program in the United States (US). Methods: All patients who underwent BPA between August 2018-2021 were included in this retrospective, single-center observational cohort. Pre-and post -procedure clinical information was collected, along with procedural characteristics. Results: Thirty patients began their BPA series during the study period. The majority of patients had segmental disease (n - 25, 83.3%). A total of 135 BPA procedures were performed on 417 segments. On average, patients completed 4.5 sessions and the majority of patients (n = 23, 76.7%) underwent more than 2. There were 24 episodes of hemoptysis and 20 procedural events that required treatment, typically with either heparin reversal or balloon tamponade. Of 26 participants with completed series, mean PA pressure (-6 mmHg, 95% CI-9 to-4 mmHg, p = 0.0001), PVR (-1.9 Wood units, 95% CI -2.9 to-1.0, p = 0.0002), and pulmonary compliance (-1.0 mL/mmHg, 95% CI-1.5 to-0.5, p = 0.0002) improved. Improvement was also seen in NYHA functional classification and walk distance (p = 0.01). Two deaths occurred, with one death peri-procedurally. Conclusion: This paper describes an early experience with BPA at a single US center. Improvement in non-invasive and invasive metrics were seen without adding a significant morbidity to an already high-risk patient population.