Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension - A Systematic Review and Meta-Analysis -

Background: Balloon pulmonary angioplasty (BPA) is a percutaneous treatment option for patients affected by chronic thromboembolic pulmonary hypertension (CTEPH) and either judged inoperable or with persistent symptoms after pulmonary endoarteriectomy. Current data regarding BPA are sparse and results vary according to local center experience. A systematic review of the literature was performed to better understand the effectiveness and safety of BPA in the treatment of CTEPH. Methods and Results: PubMed and EMBASE were searched for studies reporting BPA results in patients with CTEPH. Differences in clinical and hemodynamic parameters before and after the procedure were analyzed. Weighted mean proportion and 95% confidence intervals (CIs) of adverse events were calculated. In total, 14 studies were included (725 patients). BPA was associated with a reduction in mean pulmonary artery pressure (from 43 to 32.5 mmHg), reduction in pulmonary vascular resistance (from 9.94 to 5.06 Woods units), increase in cardiac index (from 2.35 to 2.62 L/min/m2), and improvement of 6-minute walking distance (from 345 to 442 m). Periprocedural mortality occurred in 2.1% of patients (95% CoI 0.8–4.1) while reperfusion and pulmonary vessel injuries occurred in 9.3% (95% CoI 3.1–18.4) and 2.3% (95% CoI 0.9–4.5) of total BPA sessions, respectively. Conclusions: Our systematic review suggested that BPA for CTEPH patients was an effective and relatively safe treatment option.