Applicability study of balloon pulmonary angioplasty in residual pulmonary hypertension of chronic thromboembolic pulmonary hypertension after pulmonary endarterectomy
Applicability study of balloon pulmonary angioplasty in residual pulmonary hypertension of chronic thromboembolic pulmonary hypertension after pulmonary endarterectomy
目的 探讨球囊肺动脉成形术（BPA）治疗慢性血栓栓塞性肺动脉高压（CTEPH）肺动脉内膜剥脱术（PEA）后持续肺动脉高压（PH）的安全性和有效性。 方法 连续纳入2016年12月至2022年6月在中日友好医院呼吸中心接受诊疗的CTEPH患者20例，所有入组患者经多学科讨论确定CTEPH经PEA后PH，均采用BPA进行治疗。治疗前评估患者运动耐量、肺动脉血流动力学参数，将BPA治疗前与最后1次BPA时各项参数进行对比分析。6 min步行距离（6MWD）采用配对Wilcoxon检验分析；血浆N-末端脑钠肽前体（NT-proBNP）水平、混合静脉血氧饱和度、平均肺动脉压、心脏指数和肺血管阻力（PVR）等采用配对样本t检验分析；WHO心功能分级采用McNemar检验分析。 结果 20例患者合计130支病变血管，共进行了46次BPA治疗。术后6MWD［447（415，485）m］较术前［389（335，470）m］显著改善（Z=6.52，P<0.05），术后混合静脉血氧饱和度（72.0%±1.9%）较术前（64.0%±2.7%）显著改善（t=2.14，P<0.05）。术后血浆NT-proBNP［（351.9±129.9）pg/ml］、mPAP［（24.2±1.9）mmHg］、PVR［（3.0±1.4）WU］较术前［分别为（982.5±426.2）pg/ml、（33.0±2.1）mmHg、（8.0±1.6）WU］显著减低（t值分别为3.38、1.22、2.10，P均<0.05）。术后WHO心功能分级（Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为14、4、2、0例）较术前（Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为0、13、5、2例）显著改善（χ2=20.17，P<0.05）。术后肺动脉夹层发生4例次，咯血发生1例次，无其他并发症发生。 结论 BPA能显著改善CTEPH患者PEA术后持续PH的运动耐量和血流动力学参数，手术并发症发生率相对较低，安全有效。 Objective To investigate the safety and efficacy of balloon pulmonary angioplasty (BPA) for residual pulmonary hypertension (PH) of chronic thromboembolic pulmonary hypertension(CTEPH) after pulmonary endarterectomy (PEA). Methods Patients diagnosed as PH after PEA in China-Japan Friendship Hospital from Oct 2016 to Jun 2022 were included. The indication for BPA was decided on the basis of a consensus of the multi-disciplinary team for all patients with CTEPH. Before treatment, the patient′s exercise tolerance and pulmonary artery flow parameters were evaluated. A comparative analysis of various parameters before BPA treatment and at the last BPA was conducted. 6-min walk distance (6MWD) was analyzed using the paired Wilcoxon test N-terminal pro-brain natriuretic peptide (NT-proBNP), mixed venous oxygen saturation, mean pulmonary arterial pressure (mPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were compared using the paired-samples t-test. WHO functional class was compared using McNemar′s test. Results Twenty patients with a total of 130 vessels underwent 46 sessions of BPA treatment. The postoperative 6-minute walk distance (6MWD) [447 (415, 485) m] showed a significant improvement compared to the preoperative baseline [389 (335, 470) m] (Z=6.52, P<0.05), Postoperative mixed venous oxygen saturation (72.0%±1.9%) showed a significant improvement compared to the preoperative levels (64.0%±2.7%) (t=2.14, P<0.05).Postoperatively, plasma NT-proBNP [(351.9±129.9) pg/ml], mPAP [(24.2±1.9) mmHg], and PVR [(3.0±1.4) WU] significantly decreased compared to preoperative levels [(982.5±426.2) pg/ml, (33±2.1) mmHg, (8.0±1.6) WU)] (t=3.38, 1.22, 2.10, P<0.05 for all). Postoperatively, there was a significant improvement in WHO functional class (Ⅰ，Ⅱ，Ⅲ，Ⅳ: 14, 4, 2, 0 cases) compared to preoperative status (Ⅰ，Ⅱ，Ⅲ，Ⅳ: 0, 13, 5, 2 cases) (χ2=20.17, P<0.05). Four cases of pulmonary artery dissection and one episode of hemoptysis occurred postoperatively, with no other complications reported. Conclusions BPA can significantly improve exercise tolerance and hemodynamic parameters for residual PH after PEA. BPA is a relatively safe and effective treatment for residual PH after PEA.
Abstract
Objective To investigate the safety and efficacy of balloon pulmonary angioplasty (BPA) for residual pulmonary hypertension (PH) of chronic thromboembolic pulmonary hypertension(CTEPH) after pulmonary endarterectomy (PEA). Methods Patients diagnosed as PH after PEA in China-Japan Friendship Hospital from Oct 2016 to Jun 2022 were included. The indication for BPA was decided on the basis of a consensus of the multi-disciplinary team for all patients with CTEPH. Before treatment, the patient′s exercise tolerance and pulmonary artery flow parameters were evaluated. A comparative analysis of various parameters before BPA treatment and at the last BPA was conducted. 6-min walk distance (6MWD) was analyzed using the paired Wilcoxon test N-terminal pro-brain natriuretic peptide (NT-proBNP), mixed venous oxygen saturation, mean pulmonary arterial pressure (mPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were compared using the paired-samples t-test. WHO functional class was compared using McNemar′s test. Results Twenty patients with a total of 130 vessels underwent 46 sessions of BPA treatment. The postoperative 6-minute walk distance (6MWD) [447 (415, 485) m] showed a significant improvement compared to the preoperative baseline [389 (335, 470) m] (Z=6.52, P<0.05), Postoperative mixed venous oxygen saturation (72.0%±1.9%) showed a significant improvement compared to the preoperative levels (64.0%±2.7%) (t=2.14, P<0.05).Postoperatively, plasma NT-proBNP [(351.9±129.9) pg/ml], mPAP [(24.2±1.9) mmHg], and PVR [(3.0±1.4) WU] significantly decreased compared to preoperative levels [(982.5±426.2) pg/ml, (33±2.1) mmHg, (8.0±1.6) WU)] (t=3.38, 1.22, 2.10, P<0.05 for all). Postoperatively, there was a significant improvement in WHO functional class (Ⅰ，Ⅱ，Ⅲ，Ⅳ: 14, 4, 2, 0 cases) compared to preoperative status (Ⅰ，Ⅱ，Ⅲ，Ⅳ: 0, 13, 5, 2 cases) (χ2=20.17, P<0.05). Four cases of pulmonary artery dissection and one episode of hemoptysis occurred postoperatively, with no other complications reported. Conclusions BPA can significantly improve exercise tolerance and hemodynamic parameters for residual PH after PEA. BPA is a relatively safe and effective treatment for residual PH after PEA.
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