Eleven years of balloon pulmonary angioplasty in a single center: insights into safety and efficacy

Introduction Balloon pulmonary angioplasty (BPA) has emerged as a less invasive therapeutic option for chronic thromboembolic pulmonary hypertension (CTEPH). However, its clinical efficacy and procedural safety still need comprehensive evaluation. This study aims to investigate the effects of BPA in patients with inoperable CTEPH or residual pulmonary hypertension following pulmonary endarterectomy (PEA) in a single-centre. Methods From June 2015 to February 2026, patients with symptomatic inoperable CTEPH classified as WHO functional class ≥I, as well as those with residual pulmonary hypertension (PH) after PEA, were enrolled. Clinical assessments, six-minute walking distance (6MWD), and right heart catheterization (RHC) were performed at baseline and between three to six months following the final BPA session. Data are expressed as median values with interquartile ranges. Comparative analyses of pre- and post-BPA parameters were conducted using a two-tailed paired T-test, while statistical significance for non-normally distributed data was evaluated via the Wilcoxon Signed-Rank Test. For survival analysis, baseline RHC was considered as the starting point. Results Seventy-nine patients [51% male, median age 72 years (range 36–89), median age at first contact with our center 66 years (range 24–82); 68 inoperable and 11 with residual PH after PEA] were treated in a total of 211 sessions involving 469 vessels [median number of sessions per patient: 2 (range 1–8); median number of vessels treated per patient: 5 (range 1–21)]. Seventy patients were on pulmonary arterial hypertension–specific medications prior to BPA (24 on combination therapy). All patients received lifelong anticoagulation therapy (vitamin K antagonists: 34 patients; direct oral anticoagulants: 44; fondaparinux: 1). During the procedures, 6 patients experienced a small, non–flow-limiting pulmonary artery dissection, and 20 patients had mild hemoptysis, with only 1 case requiring oro-tracheal intubation. There were 3 major vascular complications (2 arteriovenous fistulas, 1 pseudoaneurysm) and 5 minor vascular complications (groin hematoma <5 cm). A cutaneous rash occurred in 1 patient with an allergy to iodinated contrast medium. Clinical and haemodynamics results are shown in the Table 1. Out of the 79 patients, 15 died during follow-up. Causes of death included sudden death (6 patients), congestive heart failure (4 patients), hemoptysis (1 patient), sepsis (1 patient),COVID-19 (1 patient), and cancer (2 patients: tongue and kidney). One death occurred as sudden death during hospitalization. Conclusions BPA is safe and effective at improving symptoms and hemodynamic profile in inoperable CTEPH patients and in patients with residual PH after PEA.tabella--bpa--2026--final.