Chronic thromboembolic pulmonary hypertension (CTEPH) is the fourth group of pulmonary hypertension (PH) according to clinical classification. Pulmonary endarterectomy（PEA) is the preferred treatment for patients with CTEPH, however, PEA has its limitations, it only applies to the thrombi in the main, lobar, or segmental pulmonary arteries for patients with CTEPH, and the postoperative residual PH is found to be of high percentage. With the development of interventional techniques, balloon pulmonary angioplasty (BPA) has been used to treat chronic thrombotic pulmonary hypertension (CTEPH) with favorable results and has been identified as an effective and safe treatment for technically inoperable CTEPH. Balloon pulmonary angioplasty (BPA) has been accepted as a therapeutic strategy in accordance with the 2015 ESC/ESR guidelines, especially for patients with technically inoperable, an unfavorable risk-to-benefit ratio of the PEA. This study was a single-center prospective study that collects 3 time points data (before BPA, after final BPA, and follow-up ) to verify long-term safety and efficacy of BPA, as well as comparing the efficacy with targeted medical therapy, evaluating the complications of BPA, the survival of patients, and the postoperative quality of life.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
100
Percutaneous vascular access for BPA is via the femoral vein using Seldinger technique. A 5Fr sheath is inserted into the vein, through which a 6Fr long introducer sheath is advanced into the pulmonary artery. Subsequently, a 6Fr guiding catheter is advanced into the pulmonary artery being treated. Generally, selective pulmonary angiography should be performed to evaluate lesion feature before BPA. Then a 0.014-inch guidewire is used to cross the lesion, a balloon catheter of an appropriate diameter is selected to dilate the lesion.
Beijing Institute of Respiratory Medicine, Beijing Chao-yang Hospital, Capital Medical University
Beijing, China
RECRUITINGTo evaluate changes of baseline pulmonary vascular resistance (PVR) comparing to that of the final BPA and during follow-up period
The study will measure pulmonary vascular resistance (PVR) at three time points (baseline before BPA, after final BPA, and follow-up) using right heart catheterization to assess pulmonary hemodynamics by comparing the changes of PVR at above 3 time points.
Time frame: at baseline, from enrollment to end of final BPA at 9 months, at 3 months after BPA, at 9 months after BPA, at 15 months after BPA, at 27 months after BPA
To evaluate changes of baseline mean pulmonary artery pressure (mPAP) comparing to that of the final BPA and during follow-up period
The study will measure mean pulmonary artery pressure (mPAP) at three time points (baseline before BPA, after final BPA, and follow-up) using right heart catheterization to assess pulmonary hemodynamics by comparing the changes of mPAP at above 3 time points.
Time frame: at baseline, from enrollment to end of final BPA at 9 months, at 3 months after BPA, at 9 months after BPA, at 15 months after BPA, at 27 months after BPA
To observe the complications associated with BPA
The principal complications associated with BPA are pulmonary edema and pulmonary vascular injury, which may lead to symptoms such as hemoptysis, coughing or hypoxia. The study will collect data to assess the incidence of complication and identify risk factor for complications of BPA procedure.
Time frame: at baseline, from enrollment to end of final BPA at 9 months, at 3 months after BPA, at 9 months after BPA, at 15 months after BPA, at 27 months after BPA
To observe changes of baseline mixed venous oxygen saturation (SvO2) comparing to the final BPA and during follow-up
Patients with CTEPH commonly manifest hypoxia and decreased exercise capacity due to lower respiratory efficiency. This study will collect oxygen-dynamic data associated with BPA to evaluate respiratory efficiency.
Time frame: at baseline, from enrollment to end of final BPA at 9 months, at 3 months after BPA, at 9 months after BPA, at 15 months after BPA, at 27 months after BPA
To assess changes of baseline quality of life by calculating SF-36 score comparing to the final BPA and during follow-up
It has been proved that BPA improve hemodynamic in patients with inoperable CTPEH, but the effect of BPA on QoL has rarely been reported. Each patient will be asked to fill out the SF-36v2 QoL questionnaire before BPA, after final BPA and follow-up period. QoL will be evaluated on 8 scales: physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE) and mental health (MH).Then the investigator will collect 3 time points data to assess changes of QoL in patient with CTEPH.
Time frame: at baseline, from enrollment to end of final BPA at 9 months, at 3 months after BPA, at 9 months after BPA, at 15 months after BPA, at 27 months after BPA
To evaluate long-term survival after the final BPA procedure and follow-up
The primary end point for overall survival analysis is all-cause death. Long-term survival from the initial BPA procedure, the final BPA procedure and follow-up period will be evaluated.
Time frame: at baseline, from enrollment to end of final BPA at 9 months, 1 year postoperative,2 year postoperative
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