Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension: results of the Grenoble experience

Abstract : Aims: Balloon pulmonary angioplasty (BPA) is an emerging technique for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) for patient not eligible for a pulmonary endarterectomy that needs further evaluation. Methods: All consecutive patients who underwent BPA in a French centre between January 2014 and September 2016 were evaluated prospectively before BPA and between 6 and 12 months after the last treatment session on functional, biological parameters, hemodynamic and health-related quality of life (HRQOL). Results: 53 patients underwent a mean number of 3.7 sessions during 72.5±68.8 days. The follow-up was performed at 303±152 days. BPA improved WHO functional class, 6-min walk distance (mean difference, 94 m, 95% CI, 56 to 131), and NT-proBNP plasma level (1872.7±3898.9 vs 405.7±675.8pg/mL, p=0.01). Hemodynamic parameters, including mPAP (-11 mmHg, 95% CI, -14 to -7.7), PVR (-3.8 WU, 95% CI, -5.1 to -2.6), and cardiac index (0.3 L·min-1·m-2, 95% CI, 0.1 to 0.5) improved at follow-up. HRQOL evaluated by the SF36v2 and MLHFQ questionnaires was also enhanced by BPA. Complication rate was low with 6.6% of haemoptysis and 3% of reperfusion pulmonary oedema in a session-based analysis. X-ray exposure was significant with a median cumulative Air Kerma of 900mGy (IQR=556-1331mGy) and a median dose area product of 10115cGy.cm2 (IQR=6523-13779cGy.cm2) per session. Conclusion: BPA improves functional and exercise capacity, hemodynamic parameters and quality of life in CTEPH patients not eligible for pulmonary endarterectomy. Complication rate was low and included only minor complications
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Master thesis
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Nicolas Piliero. Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension: results of the Grenoble experience. Human health and pathology. 2018. ⟨dumas-01814365⟩

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