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September 10, 2025Open Access

Difference in efficacy between pulmonary endarterectomy and balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

KYKenichi YanakaKobe University Hospital KNKazuhiko NakayamaShinko Hospital YTYu TaniguchiVascular / Pulmonary Vascular

Key Points

PEA showed greater improvements in cardiac index and resistance-compliance time compared to BPA.
Patients treated with PEA had more severe pulmonary hemodynamics than those treated with BPA, with a significant mean pressure difference.
Both treatments improved clinical parameters, but BPA did not enhance cardiac index or alter RC time.
The study spans almost two decades, with outcomes assessed for 132 patients treated for CTEPH.

Abstract

Both pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) can be considered for the invasive treatment of chronic thromboembolic pulmonary hypertension (CTEPH). However, the technique applied to treat pulmonary vessels differs between PEA and BPA. While PEA removes lesions with thickened intima and organized thrombus, BPA improves pulmonary arterial flow by dilating stenosis and obstruction without removing the lesions. There have been limited reports on the differential efficacy between PEA and BPA. This study aimed to compare the baseline characteristics and efficacy of both treatments in CTEPH. Between November 2001 and May 2019, 55 patients underwent PEA and 77 had only BPA performed. We evaluated clinical parameters before performing PEA and BPA, and on follow-up. The patients who underwent BPA were older and had fewer proximal lesions and milder pulmonary hemodynamics compared with those who underwent PEA (mean pulmonary arterial pressure: 34.0 ± 8.6 vs. 43.0 ± 9.9 mm Hg, p < 0.001). Although both groups showed improvement in most of their clinical data, cardiac index was not improved by BPA as opposed to PEA (2.5 ± 0.6 to 2.5 ± 0.6 L/min/m2, p = 0.99, 2.0 ± 0.6 to 2.6 ± 0.8 L/min/m2, p < 0.001, respectively). Furthermore, RC (resistance-compliance) time was significantly decreased by PEA (0.54 ± 0.16 to 0.45 ± 0.12 s, p < 0.001), but unchanged by BPA (0.54 ± 0.16 to 0.51 ± 0.13 s, p = 0.21). BPA did not change RC time and cardiac index, while PEA reduced RC time and improved cardiac index. The technical approach of removing intra-vascular organized thrombi and thickened intima by PEA could have a more profound impact on pulmonary circulation and cardiac function improvements compared with BPA.

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