Safety of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: role of the standardized definition of complications

Literature reports high complication rates in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who undergo balloon pulmonary angioplasty (BPA), especially in patients with poor pulmonary hemodynamics. Here we describe complications of BPA based on the new definitions. All patients with CTEPH who completed BPA treatment before September 15th, 2023, were selected from the CTEPH database. Peri-procedural complications were collected and classified according to the 2023 consensus paper on BPA treatment. Complications were analyzed in subgroups of patients with pulmonary vascular resistance (PVR) [&le;] or > 6.6 WU and mean pulmonary artery pressure (mPAP) [&le;] or > 45 mmHg at first BPA. In this analysis, 87 patients (63% women; mean age 61.1{+/-}14.0 years; 62% on dual PH targeted medical therapy) underwent 426 (mean 4.9{+/-}1.6 per patient) BPAs. Only non-severe complications occurred in 14% of BPA treatments; in 47% of the patients; 31% patients had a thoracic complication. The thoracic complications were mild (71%) or moderate (29%). Patients with a PVR >6.6 WU (n=8) underwent more BPA treatments (6.6{+/-}1.5 versus 4.6{+/-}1.5, p=0.002), had more complications (88% versus 41% of patients, p=0.020), and more thoracic complications (17% vs 7% of BPAs, p=0.013) than patients with PVR [&le;]6.6 WU. Patients with mPAP >45 mmHg (n=13) also had more BPA-treatments (6.5{+/-}1.7 versus 4.6{+/-}1.4, p<0.001), more complications (77% versus 44% of patients, p=0.027) and more thoracic complications (14% versus 8% of BPAs, p=0.039) than patients with mPAP [&le;]45 mmHg. Complications occurred in 14% of BPAs and were mostly mild. Patients with severe pulmonary hemodynamics suffered more (thoracic) complications. What is known?O_LIBPA is an effective treatment in improving pulmonary hemodynamics in patients with CTEPH. C_LIO_LIBPAs are associated with a high complication rate. C_LIO_LIIn 2023 a consensus statement was published concerning the definition of complications of BPAs. C_LIO_LIPatients with poor pulmonary hemodynamics may be more susceptible to suffer from complications. C_LI What does this study add?O_LIFor the first time, complications are categorized according to the consensus statement on BPA treatments in patients with CTEPH. C_LIO_LIThoracic complication rates in patients with severe pulmonary hemodynamics are significantly higher compared to complication rates in patients with lower pulmonary hemodynamic values. C_LI