Authors: Shuliang Xia1,2 , Jianbin Li1,2 , Li Ma1,2 , Yanqin Cui1,2 , Techang Liu2,3 , Zhouping Wang2,4 , Fengxiang Li1,2 , Xumei Liu2,3 , Shan Li2,3 , Lu Sun1,2 , Lin Hu1,2, Yubin Liu5, Xun Ma1,2, Xinxin Chen1,2* and Xu Zhang2,4*
Journal: Frontiers of Cardiovascular Medicine, 23 January 2023, DOI: 10.3389/fcvm.2022.1078172
Take home points:
- Ultrahigh pressure balloons, used for pulmonary balloon angioplasty, improves the initial success rates to 78% for branch pulmonary artery stenosis
- Higher balloon to waist ratios (> 2.57) was associated with a higher initial success rate but also with a higher restenosis rate
Commentary from Dr. Thomas Zellers (Dallas, USA), section editor of Congenital Heart Disease Interventions and ACHD Journal Watch:
Summary: This is a single center retrospective evaluation of 37 patients with branch pulmonary stenosis who underwent pulmonary balloon angioplasty with ultrahigh pressure, non-compliant balloons (Conquest and Atlas balloons, up to 30 ATMs) in hopes of improving the initial and mid-term success compared to low and medium pressure balloons. The authors started with a balloon to waist ratio up to 3 with a maximum ration of 5. They evaluated immediately after the procedure with the longest follow up of only 10 months.
The authors used the following to designate success:
- A ≥ 50% increase in the vessel diameter at the stenotic site
- A ≥ 50% decrease in the pressure gradient across the stenosis
- A ≥ 20% decrease in the ratio of right to left ventricular systolic pressure or the ratio decreased to below 0.5.
With these parameters, the success rate was 78.4%. The use of Ultrahigh angioplasty balloons significantly increased the pulmonary artery diameter (97%) and reduced the gradients across the stenosis (54%; see Table 4). The RV:LV pressure ratio was only reduced, on average, by 12%. The balloon: waist ratio differentiated between success and failure at > 2.57 with a sensitivity of 0.724 and a specificity of 0.875. The presence of therapeutic tears occurred in 27% of the success group but was not present in the failure group.
There were no deaths reported. Sixteen patients suffered adverse events with 11 cases of pulmonary artery injury, 3 patients with pulmonary hemorrhage (resolved with 53 hours), and 2 patients with pulmonary artery aneurysm which did not progress in the short term. Restenosis occurred in 9 patients; 8 of 9 had initial success with balloon:waist ratios > 2.57. Hence, high balloon:waist ratios did not prevent restenosis.
Limitations: There are a few limitations to the study. It is retrospective, not controlled for balloon:waist size despite it being a single center study and the follow up was very short so longer term results are not yet known. While it is encouraging that the authors saw a better immediate angioplasty result, the long term results are lacking.
Tables:
Table 4
Figure 1
