Balloon pulmonary angioplasty vs. pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis

Abstract

Although balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) are effective in chronic thromboembolic pulmonary hypertension (CTEPH), the comparison of their efficacy and safety is still unclear. We identified studies through a systematic review of PubMed, Cochrane Library, and Embase and used a random effects meta-analysis model to synthesize estimates of weighted mean differences or combined effect size. In total, 54 studies were included in this meta-analysis. The survival rates at perioperative/in-hospital period, 2 years, and 3 years were 100%, 99%, and 97%, respectively, in BPA group and 93%, 90%, and 88%, respectively, in PEA group. The variation of 6-min walk distance was 141.80 m in BPA and 100.73 m in PEA when the follow-up was 1–6 months. At < 1-month, 1–6-month, and > 12-month follow-up, the changed results of mean pulmonary arterial pressure were − 18.31, − 17.00, and − 12.97 mmHg in BPA group and − 18.93, − 21.21, and − 21.35 mmHg in PEA group. At < 1-month and 1–6-month follow-up, the changed values of pulmonary vascular resistance were − 542.24 and − 599.77 dyne•s•cm−5 in PEA group and − 443.49 and − 280.00 dyne•s•cm−5 in BPA group. In addition, there was more wide variety of complications in PEA group than in BPA group. BPA might have higher survival rate (perioperative/in-hospital period, 2-year and 3-year follow-up) and fewer types of complications compared with PEA. The improvement in exercise capacity (1–6-month follow-up) in the BPA group might be more pronounced than in PEA group. Moreover, PEA might be superior in improvement of hemodynamic parameters (< 1-month, 1–6-month, and > 12-month follow-up).

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Data availability

The data are transparency.

Code availability

This study was using Stata 13.0 (StataCorp, TX) and GraphPad Prism (version 8; GraphPad Software, Inc) for analyzing the data.

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Funding

This study was supported by the National Natural Science Foundation of China (grant no. 81860059), the International Cooperation Exchange Project of Gansu Province (grant no. 18YF1WA046) granted to MZ and CAS ‘Light of West China’ Program granted to MZ and YSC.

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All authors contributed to the study conception and design. Liyan Zhang, Yuping Bai, and PeijingYan analyzed the patient data and were the major contributors in the preparation of the manuscript. Tingting He and Bin Liu analyzed part of the patient data. Shanlian Wu performed the literature search and extracted the data. Zhen Qian was responsible for the statistical analysis. Changtian Li made substantial contributions to the conception of the study. The first draft of the manuscript was written by Min Zhang and Yunshan Cao and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yunshan Cao or Min Zhang.

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Zhang, L., Bai, Y., Yan, P. et al. Balloon pulmonary angioplasty vs. pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis. Heart Fail Rev (2021). https://doi.org/10.1007/s10741-020-10070-w

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Keywords

  • Chronic thromboembolic pulmonary hypertension
  • Balloon pulmonary angioplasty
  • Pulmonary endarterectomy
  • Efficacy
  • Safety
  • Systematic review and meta-analysis