The paper of Brenot et cols shows the most significant experience in BPA outside Japan in an Expert CTEPH center. From 2014 to 2017, 184 inoperable CTEPH patients underwent 1006 BPA sessions. The main objective was to analyze the safety and efficacy of BPA. The inclusion time for patients was divided into two phases ( initial vs. recent) to evaluate the impact of the learning curve on BPA results.
BPA patients experienced a significant improvement in the New York Heart Association functional class and in the 6-min walk distance (mean change +45 m). Additionally mean pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) decreased by 26% and 43%, respectively.
However, we shouldn't forget the risk of the procedure. BPA related complications occurred in 113 of 1006 sessions (11.2% of all sessions and 46% of all patients). There were four periprocedural deaths (within 30 days after BPA; 2.2%) which were related to severe lung injury. Handling these situations is difficult. Local ECMO availability and expertise in the treatment of CTEPH patients should be mandatory. A higher PVR value was associated with higher rate of BPA periprocedural complications, resembling complications after pulmonary endarterectomy surgery.
The team learning curve had a great influence on BPA results. BPA efficacy and the rate of complications improved over time. In the recent period, the decrease in PVR was significantly higher, and the number of major injuries was minimized.
Taking all these points together, we can summarize that BPA is a safe and effective treatment for CTEPH not amenable for surgery. It is highly advisable to perform BPA at CTEPH expert centers. This will provide the most effective results by enhancing the team's experience and improving BPA safety by ensuring the correct treatment of complications