Balloon Pulmonary Angioplasty for Treatment of Chronic Thromboembolic Pulmonary Hypertension: Statement From the BPA-CTEPH Alliance.

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by fibrothrombotic pulmonary vascular obstruction and associated small-vessel vasculopathy resulting in a progressive increase in pulmonary vascular resistance and right heart failure. Pulmonary thromboendarterectomy is the first-line treatment for surgically accessible disease. However, many patients are ineligible because of surgically inaccessible distal disease, medical comorbidities, or symptomatic residual disease after pulmonary thromboendarterectomy. Balloon pulmonary angioplasty (BPA) has emerged as a very effective therapeutic option in these patients. This statement from the BPA-CTEPH Alliance reviews the role of BPA in CTEPH, describing patient selection, procedural techniques, periprocedural management, complications, and training requirements. This U.S.-focused document provides practical guidance for establishing a BPA program within a multidisciplinary CTEPH center. Technical refinement and improved patient selection have significantly enhanced the safety and efficacy of BPA. Contemporary evidence suggests that BPA is associated with significant improvements in pulmonary vascular resistance, mean pulmonary artery pressure, functional class, and quality of life. There is a considerable learning curve associated with BPA, and complication rates, once prohibitive, have substantially decreased with operator experience and with adjunct medical therapy. BPA has become a critical component of multimodality management of CTEPH, with durable hemodynamic and clinical benefits. Continued research, with a particular focus on randomized controlled trials in the United States, is crucial to defining long-term outcomes and expanding access to this lifesaving therapy.