Clinical Cases Preventive coronary protection during TAVI in a patient with high risk of coronary obstruction
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| Introduction Balloon pulmonary angioplasty (BPA) is a growing treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Objective: The aim of the study was to describe our early experience with this technique. Methods and Results Retrospective study including all patients undergoing BPA for chronic thromboembolism pulmonary hypertension (CTEPH) from January 2020 to February 2024 at a single center. Efficacy was assessed as drop in pulmonary pressure (mPAP) and increase in 6 minutes walking test (6MWT), and safety as all adverse events during hospital stay. Twenty-nine BPA sessions were performed in 7 patients with CTEPH, of whom 2 are still under treatment. Mean BPA sessions per patient was 3 (3-6). Most patients were female (66%), and the median age was 70 (52-83) years old, although a very young patient (35) and very old (85) were treated. Most patients (66%) had a history of pulmonary embolism, and only one had antiphospholipid syndrome. Other factors for CTEPH included a permanent vena cava filter and a portacath in one patient. Reasons for BPA were high surgical risk (n=4), distal disease (n=2) and recurrence after endarterectomy (n=1). Regarding the procedures (n=29) the number of lobes treated per session was 1.17 +- 0.3, the number of segmental branches treated per session was 1.9 +- 0.7. The size of the balloons used were 3.5 +- 1 mm, and the amount of contrast used per session was 249 +- 71 ml. Most sessions were performed with Judkins Right 3.5 (48%) and Judkins Left 3.5 (20%) guiding catheters. All BPA sessions were successful in dilating at least one segment except one case for a total reocclusion after endarterectomy. All patients achieved significant hemodynamic improvement, as evidenced by a decrease in mean Pulmonary arterial pressure (51.5 +- 3 mmHg vs 39 +-11 mmHg, p=0.04, before and after BPA respectively) and an increase in 6MWT (73 +- 15 meters, n=5. Also in patients with before and after )brain natriuretic peptides levels (n=6), a strong reduction was observed with BPA (mean decrease 1716+-2114 pg/ml) all patients showed normal levels after BPA according to laboratory cutoffs. Hemoptysis was the most common complication, observed in 10% of sessions. Reperfusion pulmonary edema requiring non invasive ventilation was observed in one procedure (3%) without any need for mechanical ventilation. Pulmonary vascular injury associated with contrast extravasation was observed in 2 procedures (7%). Finally, there was a rare bleeding complication due to iatrogenic right internal iliac artery laceration during venous access, causing retroperitoneal hematoma at day 3 after BPA, requiring urgent surgical intervention. No in-hospital death was recorded. Conclusions BPA is a reproducible effective treatment in selected CTEPH patients. Ouir initial experience shows improvement in patients associated with an adequate safety profile. | |||
| Attached Documents | |||
| Obstruction.pptx | |||