Efficacy and Long-term Mortality After Balloon Pulmonary Angioplasty in Older Patients With Chronic Thromboembolic Pulmonary Hypertension.

Background: Balloon pulmonary angioplasty (BPA) has shown short-term safety and efficacy for treating chronic thromboembolic pulmonary hypertension (CTEPH). However, it remains unclear whether these effects, as well as long-term mortality after BPA, differ depending on patient age. We investigated the safety, short-term efficacy (hemodynamics, functional capacity, and respiratory function), and long-term mortality of BPA treatment in both younger and older patients with CTEPH.

Methods: We enrolled 157 consecutive patients with CTEPH who underwent BPA at a university hospital. They were divided into 2 age groups: older (≥ 75 years, n = 39) and younger (< 75 years, n = 118). Hemodynamics, functional capacity, and respiratory function were evaluated at baseline, 1 week, 6 months, and 1 year post-BPA. Procedure-related complications, all-cause mortality, and cause of mortality were assessed during hospitalization for BPA and throughout the follow-up period (median duration 5.7 years).

Results: BPA improved the mean pulmonary artery pressure, pulmonary vascular resistance, 6-minute walking distance, and pulmonary diffusion capacity in both age groups. There was no all-cause mortality or use of extracorporeal membrane oxygenation during hospitalization in either group; however, the rates of noninvasive positive pressure ventilation use and intraoperative hemosputum/hemoptysis were higher in the older group. All-cause mortality was higher in the older group during the follow-up period, but all cases were unrelated to pulmonary hypertension (PH).

Conclusions: BPA was effective for improving hemodynamics, functional capacity, and respiratory parameters without critical complications, regardless of patient age. The older patients in our cohort had a higher mortality rate that was unrelated to PH.