Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-analysis

Purpose To perform a systematic review and meta-analysis assessing the safety and efficacy of balloon pulmonary angioplasty (BPA) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Materials and Methods Systematic literature searches were performed from inception to June 2022 to identify studies assessing BPA for CTEPH. Outcomes of interest included the following functional and hemodynamic measures: (a) six-minute walk distance (6MWD), (b) New York Heart Association (NYHA) status, (c) World Health Organization (WHO)-Functional Class status, (d) cardiac index (CI), (e) mean pulmonary artery pressure (mPAP), (f) mean right atrial pressure (mRAP), and (g) pulmonary vascular resistance (PVR). Subgroup analysis was also performed for BPA in post-pulmonary endarterectomy (PEA) patients. All reported BPA-related complications were also recorded. Forty unique studies with a total of 1763 patients were identified for meta-analysis. Results All functional and hemodynamic parameters improved significantly following BPA; 6MWD increased 70 m (95% CI 58–82; P < 0.001), NYHA class improved by − 0.9 classes (95% CI − 1.0 to − 0.8; P < 0.001), WHO-FC class improved by − 1 classes ((95% CI − 1.2 to − 0.9; P < 0.001), CI increased 0.26 L/min/m 2 (95% CI 0.17–0.35; P < 0.001), mPAP decreased − 13.2 mmHg (95% CI − 14.7 to − 11.8; P < 0.001), mRAP decreased − 2.2 mmHg (95% CI − 2.8 to − 1.6; P < 0.001), and PVR decreased − 311 dyne/cm/s −5 (95% CI − 350 to − 271; P < 0.001). Meta-analysis of patients who underwent BPA for persistent pulmonary hypertension post-PEA demonstrated significant improvements in 6MWD, WHO-FC, PVR and mPAP. Most common complications included lung injury (8.16%), hemoptysis (7.07%) and vessel injury (5.05%). Conclusion BPA represents a safe and effective treatment option for select individuals with CTEPH with significant improvements in hemodynamic parameters, improved exercise tolerance and a relatively low risk of major complications.