• Nobuhiro Tanabe, Takashi Kawakami, Toru Satoh, Hiromi Matsubara, Norifumi Nakanishi, Hitoshi Ogino, Yuichi Tamura, Ichizo Tsujino, Aiko Ogawa, Seiichiro Sakao, Mari Nishizaki, Keiichi Ishida, Yasunori Ichimura, Masahiro Yoshida, and Koichiro Tatsumi.
• Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: ntanabe@faculty.chiba-u.jp.
• Respir Investig. 2018 Jul 1; 56 (4): 332-341.

BackgroundBalloon pulmonary angioplasty (BPA) has been performed for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual pulmonary hypertension after pulmonary endarterectomy (PEA). We performed a systematic review to assess the efficacy and safety of BPA, especially compared to medical treatment or PEA.MethodsWe reviewed all studies investigating pre- and post-treatment pulmonary hemodynamics, mortality, or complications from three electronic databases (PubMed, Cochrane Library, Japan Medical Abstracts Society) prior to February 2017. From 26 studies retrieved, we selected 13 studies (493 patients): the 10 most recent ones including complete data from each institution, one study of residual pulmonary hypertension, and two studies comparing BPA with medical treatment or PEA.ResultsNo randomized controlled or prospective controlled studies comparing BPA with medical treatment or PEA were reported. The early mortality of BPA ranged from 0% to 14.3%; lung injury occurred in 7.0% to 31.4% (average sessions, 2.5-6.6). Mean pulmonary arterial pressure decreased from 39.4-56 to 20.9-36 mm Hg, and the 6-min walk distance increased from 191-405 to 359-501 m. The 2-year mortality of 80 patients undergoing BPA was significantly lower compared to 68 patients receiving medical treatment (1.3% vs. 13.2%); the risk ratio was 0.14 (95% confidence interval: 0.03-0.76). No significant difference was observed in the 2-year mortality between BPA (n=97) and PEA (n=63) patients.ConclusionsThis systematic review suggests that BPA improves hemodynamics, has acceptable early mortality, and may improve long-term survival compared with medical treatment in inoperable CTEPH patients.Copyright © 2018 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

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