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 

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1001518

DOI=10.3389/fcvm.2022.1001518

ISSN=2297-055X

ABSTRACT=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) may be an attractive less invasive therapy for elderly patients. However, information about the safety, 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, retrospective series included consecutive patients aged ≥70 years who underwent a completed or interrupted BPA program 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 ≥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(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/m2;p=0.04) with significant NT proBNP reduction (pre-BPA, 353 pg/mL [207-1960 pg/mL] vs. post-BPA, 167 pg/mL [73-629 pg/mL];p=0.03). The patients’ functional class improved as well, and pulmonary hypertension-targeting drug requirements reduced significantly. Pulmonary injury appeared in 3.4% of the 116 procedures, 50% were grade 2. No patient ≥70 years had grade 5 pulmonary injury. One periprocedural mortality was recorded (3%). Median follow-up was 2.8 years. The survival rate of entire cohort at 1 and 3 years was 90.5% and 82.8%, respectively.
Conclusions
BPA is an is effective and safe approach in patients ≥70 years. It significantly improves patients’ functional class, hemodynamic and biomarkers and reduces pulmonary hypertension-targeting drugs 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 and comparable to that of younger patients undergoing BPA.