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Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients

BACKGROUND: Advanced age, frailty, and age-related comorbidities are the major causes of pulmonary endarterectomy disqualification in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) is an attractive and less invasive therapy for elderly patien...

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Autores principales: Velázquez Martín, Maite, Maneiro Melón, Nicolás, Albarrán González-Trevilla, Agustín, Sarnago Cebada, Fernando, Huertas Nieto, Sergio, Cruz-Utrilla, Alejandro, Hinojosa, Williams, López-Gude, María Jesús, Alonso Charterina, Sergio, Revilla Ostolaza, Yolanda, Aguilar Colindres, Ricardo José, Arribas Ynsaurriaga, Fernando, Escribano Subias, Pilar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9640701/
https://www.ncbi.nlm.nih.gov/pubmed/36386311
http://dx.doi.org/10.3389/fcvm.2022.1001518
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author Velázquez Martín, Maite
Maneiro Melón, Nicolás
Albarrán González-Trevilla, Agustín
Sarnago Cebada, Fernando
Huertas Nieto, Sergio
Cruz-Utrilla, Alejandro
Hinojosa, Williams
López-Gude, María Jesús
Alonso Charterina, Sergio
Revilla Ostolaza, Yolanda
Aguilar Colindres, Ricardo José
Arribas Ynsaurriaga, Fernando
Escribano Subias, Pilar
author_facet Velázquez Martín, Maite
Maneiro Melón, Nicolás
Albarrán González-Trevilla, Agustín
Sarnago Cebada, Fernando
Huertas Nieto, Sergio
Cruz-Utrilla, Alejandro
Hinojosa, Williams
López-Gude, María Jesús
Alonso Charterina, Sergio
Revilla Ostolaza, Yolanda
Aguilar Colindres, Ricardo José
Arribas Ynsaurriaga, Fernando
Escribano Subias, Pilar
author_sort Velázquez Martín, Maite
collection PubMed
description BACKGROUND: Advanced age, frailty, and age-related comorbidities are the major causes of pulmonary endarterectomy disqualification in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) is an attractive and less invasive therapy for elderly patients. However, information about the safety, procedure tolerance, and effectiveness of BPA in elderly patients is limited. OBJECTIVE AND METHODS: We aimed to analyze the safety, tolerance, and efficacy of BPA in CTEPH patients aged ≥70 years. This observational, descriptive, and retrospective series included consecutive patients aged ≥70 years, who underwent completed or interrupted BPA programs at a pulmonary hypertension reference center between May 2013 and May 2022. RESULTS: We enrolled 155 patients in our institution's BPA program. Among these, 33 patients were aged ≥70 years (mean age, 76.4 years; women, 75.8%) and had finished or interrupted BPA programs. In this cohort, we performed 116 BPA procedures (average, 3.6 ± 1.8 sessions/patient). Among the 33 patients, 19 (57.6%) completed treatment for all lobes, while the BPA program was interrupted in the remaining 14 (42.4%). Among all 33 patients, BPA was associated with a significant reduction in mean pulmonary arterial pressure (39.2 ± 9.3 vs. 32.8 ± 8.8 mmHg; p < 0.001) and pulmonary vascular resistance (6.7 ± 3.1 vs. 4.4 ± 2.0 WU; p < 0.001), along with an improvement in the cardiac index (2.5 ± 0.6 vs. 2.8 ± 0.7 L/min/m(2); p = 0.04) with significant reductions in the N-terminal prohormone of brain natriuretic peptide level (pre-BPA, 353 pg/mL [207–1,960 pg/mL] vs. post-BPA, 167 pg/mL [73–629 pg/mL]; p = 0.03). The patients' functional class improved, and pulmonary hypertension-targeting drug requirements were significantly reduced. The pulmonary injury appeared in 3.4% of the 116 procedures, of which 50% were of grade 2. No patient of ≥70 years had grade 5 pulmonary injury. One periprocedural mortality was recorded (3%), and the median follow-up period was 2.8 years. The survival rate of the entire cohort at 1 and 3 years was 90.5 and 82.8%, respectively. CONCLUSION: BPA is an effective and safe approach in patients aged ≥70 years. It significantly improves patients' functional class, hemodynamic, and biomarkers, and reduces their pulmonary hypertension-targeting medical therapy requirements. These successes were achieved even though a significant percentage of patients did not complete the therapy. The rates of procedural complications and periprocedural mortality were low. Survival at 1 and 3 years was good in comparison to that of younger patients undergoing BPA.
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spelling pubmed-96407012022-11-15 Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients Velázquez Martín, Maite Maneiro Melón, Nicolás Albarrán González-Trevilla, Agustín Sarnago Cebada, Fernando Huertas Nieto, Sergio Cruz-Utrilla, Alejandro Hinojosa, Williams López-Gude, María Jesús Alonso Charterina, Sergio Revilla Ostolaza, Yolanda Aguilar Colindres, Ricardo José Arribas Ynsaurriaga, Fernando Escribano Subias, Pilar Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Advanced age, frailty, and age-related comorbidities are the major causes of pulmonary endarterectomy disqualification in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) is an attractive and less invasive therapy for elderly patients. However, information about the safety, procedure tolerance, and effectiveness of BPA in elderly patients is limited. OBJECTIVE AND METHODS: We aimed to analyze the safety, tolerance, and efficacy of BPA in CTEPH patients aged ≥70 years. This observational, descriptive, and retrospective series included consecutive patients aged ≥70 years, who underwent completed or interrupted BPA programs at a pulmonary hypertension reference center between May 2013 and May 2022. RESULTS: We enrolled 155 patients in our institution's BPA program. Among these, 33 patients were aged ≥70 years (mean age, 76.4 years; women, 75.8%) and had finished or interrupted BPA programs. In this cohort, we performed 116 BPA procedures (average, 3.6 ± 1.8 sessions/patient). Among the 33 patients, 19 (57.6%) completed treatment for all lobes, while the BPA program was interrupted in the remaining 14 (42.4%). Among all 33 patients, BPA was associated with a significant reduction in mean pulmonary arterial pressure (39.2 ± 9.3 vs. 32.8 ± 8.8 mmHg; p < 0.001) and pulmonary vascular resistance (6.7 ± 3.1 vs. 4.4 ± 2.0 WU; p < 0.001), along with an improvement in the cardiac index (2.5 ± 0.6 vs. 2.8 ± 0.7 L/min/m(2); p = 0.04) with significant reductions in the N-terminal prohormone of brain natriuretic peptide level (pre-BPA, 353 pg/mL [207–1,960 pg/mL] vs. post-BPA, 167 pg/mL [73–629 pg/mL]; p = 0.03). The patients' functional class improved, and pulmonary hypertension-targeting drug requirements were significantly reduced. The pulmonary injury appeared in 3.4% of the 116 procedures, of which 50% were of grade 2. No patient of ≥70 years had grade 5 pulmonary injury. One periprocedural mortality was recorded (3%), and the median follow-up period was 2.8 years. The survival rate of the entire cohort at 1 and 3 years was 90.5 and 82.8%, respectively. CONCLUSION: BPA is an effective and safe approach in patients aged ≥70 years. It significantly improves patients' functional class, hemodynamic, and biomarkers, and reduces their pulmonary hypertension-targeting medical therapy requirements. These successes were achieved even though a significant percentage of patients did not complete the therapy. The rates of procedural complications and periprocedural mortality were low. Survival at 1 and 3 years was good in comparison to that of younger patients undergoing BPA. Frontiers Media S.A. 2022-10-25 /pmc/articles/PMC9640701/ /pubmed/36386311 http://dx.doi.org/10.3389/fcvm.2022.1001518 Text en Copyright © 2022 Velázquez Martín, Maneiro Melón, Albarrán González-Trevilla, Sarnago Cebada, Huertas Nieto, Cruz-Utrilla, Hinojosa, López-Gude, Alonso Charterina, Revilla Ostolaza, Aguilar Colindres, Arribas Ynsaurriaga and Escribano Subias. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Velázquez Martín, Maite
Maneiro Melón, Nicolás
Albarrán González-Trevilla, Agustín
Sarnago Cebada, Fernando
Huertas Nieto, Sergio
Cruz-Utrilla, Alejandro
Hinojosa, Williams
López-Gude, María Jesús
Alonso Charterina, Sergio
Revilla Ostolaza, Yolanda
Aguilar Colindres, Ricardo José
Arribas Ynsaurriaga, Fernando
Escribano Subias, Pilar
Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients
title Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients
title_full Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients
title_fullStr Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients
title_full_unstemmed Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients
title_short Balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients
title_sort balloon pulmonary angioplasty can be an effective and safe therapeutic option in non-surgical elderly patients
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9640701/
https://www.ncbi.nlm.nih.gov/pubmed/36386311
http://dx.doi.org/10.3389/fcvm.2022.1001518
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