Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension
More Work to Be Done
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Although there are several iterations of the same theme, Albert Einstein once proclaimed, “The more I learn, the more I realize how much I don’t know.” An interpretation of this notion is that each step forward in discovery simply leads to more questions to answer. The expanding experience with balloon pulmonary angioplasty worldwide in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) is reminiscent of Einstein’s assertion. In this month’s issue of Circulation: Cardiovascular Quality and Outcomes, Ogawa et al1 report the combined outcomes from 7 institutions in Japan performing balloon pulmonary angioplasty on patients with inoperable CTEPH. And although the information provided in this article is of considerable value, many unanswered questions remain.
See Article by Ogawa et al
The aggregate data presented in this multicenter Japanese balloon pulmonary angioplasty (BPA) registry provides a clearer characterization of patients undergoing this intervention—80% were female, medical conditions previously reported to be associated with CTEPH were uncommon, thrombophilic disorders were seen in 8.8% of patients, only 15.3% of patients had a prior episode of acute pulmonary embolism, and 34.7% were with a deep venous thrombosis history. This patient phenotype is distinctly different from that reported in large series of CTEPH patients where the male to female ratio is nearly even and a much higher percentage of patients having been identified as experiencing a previous pulmonary embolic event.2 This raises the issue as to whether the patient type is distinct in this series and, as a consequence, whether the reported outcomes are transferable to other BPA-experienced centers. It might be argued that the patient characteristics in the Japanese Registry may be reflective of those at risk for developing inoperable chronic thromboembolic disease. However, published information from several European BPA centers are more …