Safe and Effective Balloon Pulmonary Angioplasty in the Outpatient Setting: The Michigan Medicine Experience

Lucas Rich; Nimai Patel; Syed N Hyder; Hitinder Gurm; Victor Moles; Prachi P Agarwal; Scott Visovatti; Jonathan Haft; Thomas Cascino; Vallerie V Mclaughlin; Vikas Aggarwal

doi:10.1016/j.jscai.2023.100589

Safe and Effective Balloon Pulmonary Angioplasty in the Outpatient Setting: The Michigan Medicine Experience

J Soc Cardiovasc Angiogr Interv. 2023 Feb 2;2(2):100589. doi: 10.1016/j.jscai.2023.100589. eCollection 2023 Mar-Apr.

Authors

Affiliations

¹ Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
² Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
³ Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan.
⁴ Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
⁵ Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
⁶ Section of Cardiology, Department of Internal Medicine, Veterans Affairs Medical Center, Ann Arbor, Michigan.

Abstract

Background: Balloon pulmonary angioplasty (BPA) is currently performed at select centers worldwide, with the current standard of practice being postprocedural inpatient monitoring for 24 to 72 hours. We sought to evaluate the safety and efficacy of BPA in a cohort of patients with chronic thrombo-embolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH) and outline a protocol for implementation in the outpatient setting.

Methods: All patients with distal, inoperable CTEPH, residual symptoms after pulmonary endarterectomy, or symptomatic CTEPD from July 1, 2020, to June 30, 2022, were evaluated by a multidisciplinary chronic thromboembolic pulmonary hypertension team for consideration of BPA. Patients undergoing each BPA session adhered to a regimented protocol developed and implemented at our institution. Safety and efficacy were retrospectively evaluated with a mean follow-up time of 8.5 months.

Results: Eighteen patients underwent a total of 78 BPA sessions. Overall, there was a significant improvement in World Health Organization functional class and mean improvement in 6-minute walking distance of +67 m. Hemodynamic parameters significantly improved with a mean decrease in mean pulmonary artery pressure and pulmonary vascular resistance of 7.3 ± 5.8 mm Hg and 1.7 ± 1.5 Wood units, respectively (P <.05). Complication rates were low with 3 (3.9%) of 78 patients developing scant hemoptysis and 1 (1.3%) of 78 experiencing vascular injury requiring inpatient hospitalization.

Conclusions: BPA is both safe and effective when implemented in the outpatient setting using a regimented protocol provided there are necessary contingencies in place.

Keywords: balloon pulmonary angioplasty; chronic thromboembolic pulmonary disease; chronic thromboembolic pulmonary hypertension; outpatient interventional procedures.