Long-Term Survival of Balloon Pulmonary Angioplasty for Inoperable Chronic Thromboembolic Pulmonary Hypertension

BACKGROUND: Balloon pulmonary angioplasty (BPA) is recommended for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). OBJECTIVES: The aim of this study was to evaluate the long-term survival benefit of BPA for inoperable CTEPH, especially partial BPA sessions. METHODS: In this multicenter cohort study, 232 patients undergoing BPA (the BPA group) and 70 patients refusing the BPA procedure (the non-BPA group) were enrolled. The BPA group was further divided into the full-BPA group (129 patients) and the partial-BPA group (103 patients). The primary outcome was all-cause mortality. RESULTS: During a median follow-up time of 6.0 years (Q1-Q3: 3.7-7.3), 17 and 26 patients in the BPA and non-BPA groups died, contributing to 8-year survival rates of 86.7% (95% CI: 80.1%-93.8%) and 57.8% (95% CI: 45.9%-72.8%) in the BPA and non-BPA groups, respectively (P < 0.001, log-rank test). BPA was associated with significantly reduced all-cause mortality in inoperable CTEPH patients (HR: 0.20; 95% CI: 0.12-0.32; P < 0.001). In secondary analysis, the 8-year survival rates were 97.1% (95% CI: 93.8%-99.9%) and 70.0% (95% CI: 55.8%-87.8%) in the full-BPA and partial-BPA groups, respectively, both better than the non-BPA group (P < 0.001, log-rank test). Compared with the non-BPA group, partial BPA was associated with significantly reduced all-cause mortality in inoperable CTEPH patients (HR: 0.38; 95% CI: 0.22-0.70; P = 0.001). CONCLUSIONS: BPA tended to be associated with a reduced risk for all-cause mortality in patients with inoperable CTEPH, even those undergoing partial BPA sessions. These findings are preliminary and must be confirmed in randomized controlled trials.