Greater experience in balloon pulmonary angioplasty (BPA) enables shorter hospital stays for patients with chronic thromboembolic pulmonary hypertension (CTEPH), reduces use of intensive care, and lowers medical costs while maintaining the procedure’s safety, according to new data from real-world practice in Japan.
The study, “Shortening Hospital Stay Is Feasible and Safe in Patients With Chronic Thromboembolic Pulmonary Hypertension Treated With Balloon Pulmonary Angioplasty,” was published in the Canadian Journal of Cardiology.
In BPA, a fine wire is inserted into blocked or narrowed blood vessels in the lungs to position a balloon. When inflated for a few seconds, the balloon inflates, pushing the blockage aside and restoring blood flow.
BPA has shown evidence in improving hemodynamics (blood flow) and exercise capacity of CTEPH patients. However, there have been no studies to address whether this procedure enables shorter hospital stays and reduced use of intensive care units.
Researchers from Japan’s Keio University School of Medicine enrolled 123 CTEPH patients who had undergone BPA between November 2012 and September 2017. The patients’ mean age was 66 years, ranging from 54 to 74 years. The patients were in World Health Organization (WHO) functional class II (27 patients), III (88), or IV (8).
BPA was performed in multiple sessions (mean of six sessions per patient) to prevent complications such as pulmonary injury, contrast-induced nephropathy (CIN, impaired renal function after intravenous contrast administration), and excessive radiation exposure. The mean number of targeted blood vessels per patient was 14.
All patients underwent right heart catheterization to measure their right atrial pressure — the blood pressure in the heart’s right atrium, one of its upper chambers — and pulmonary artery pressure prior to and one week after BPA. Cardiac output, pulmonary vascular resistance, and two cardiac biomarkers — brain natriuretic peptide (BNP) and high sensitivity-troponin (hs-TnT) — were also assessed.
BPA-associated complications were assessed, as were total medical costs such as fees for consultation, medications, laboratory and radiologic testing, surgery, rehabilitation, hospital room and nursing, and anesthesia.
Results showed that BPA enabled a significant improvement in right atrial and pulmonary artery pressures, as well as in pulmonary vascular resistance. Furthermore, the levels of BNP (a biomarker of cardiac dysfunction), and hs-TnT (a biomarker of acute myocardial infarction) were decreased. In contrast, cardiac output was unchanged after BPA.
The total length of hospital stay per patient was 41 days, 6.6 days per BPA session. Most patients (72) spent fewer than seven days per BPA session in the hospital. Compared to those who spent longer periods hospitalized, there were no differences in biomarker levels, cardiac parameters, or WHO functional class.
Importantly, the length of hospital stay decreased with a later date of BPA (more recent, between August 2015 and June 2017) — early phase 7.9 (November 2012 to May 2014), middle phase 6.5 (June 2014 to July 2015), and late phase 6.0 days per session (August 2015 and June 2017). Similar decreases were found in medical costs, use of intensive care, and frequency of chest computed tomography, which were avoided in patients in late-phase BPA.
A subsequent statistical analysis demonstrated that only the early BPA phase was significantly associated with hospital stays of seven days or longer per session.
In contrast, the reduction in length of hospital stay had no effect on the incidence of BPA-related complications, such as the rate of pulmonary injury, CIN, severe pulmonary injury needing intubation, cardiopulmonary collapse requiring blood flow support, death, or readmittance to the hospital.
“Increasing experience with BPA was associated with a reduction in LOHS (length of hospital stay) and the use of intensive/high care unit, but no change was noted in the rate of BPA-related complications,” the scientists said.
Despite including a limited number of patients in only one center, the findings “suggest that the reduction in both LOHS and use of the intensive care unit for BPA is feasible and does not jeopardize the safety of the procedure,” the team concluded.