Pulmonary Endarterectomy After Balloon Pulmonary Angioplasty: A Single‐Center USA Experience
- 1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine University of California San Diego San Diego California USA.
- 2Division of Cardiovascular and Thoracic Surgery, Department of Surgery University of California San Diego San Diego California USA.
Abstract
Pulmonary endarterectomy (PEA) is the treatment of choice for operable chronic thromboembolic pulmonary hypertension (CTEPH), while balloon pulmonary angioplasty (BPA) is reserved for inoperable disease. However, operability is subjective and there are patients who may undergo BPA prior to PEA. It is not clear if prior BPA affects PEA outcomes. We present a series of patients from a single, high-volume, referral center who underwent PEA after prior BPA. CTEPH patients who underwent BPA prior to undergoing PEA at the University of California, San Diego between January 2013 and July 2025 were included. Post-PEA outcomes were compared to all PEA patients who did not have prior BPA from the year 2022. Twenty-one patients were identified. Average number of BPA sessions prior to PEA was 3.4 ± 2.1. The most common reason for initial BPA was distal disease deemed inoperable (43%). Average total circulatory arrest time was 61.5 ± 21.8 min, compared to 47.9 ± 19.3 min (p = 0.003) in the control PEA cases (n = 188). Post-operatively, the PEA after BPA cohort had longer ventilator days (p < 0.001), ICU days (p = 0.022) and post-operative length of stay (LOS) (p < 0.001); there were also higher rates of post-operative bleeding (p < 0.001) requiring transfusions (p = 0.033) and return to the operating room (p = 0.008). There was one death related to prior BPA complications despite adequate endarterectomy with improved hemodynamics. There was similar hemodynamic improvement post-operatively in both cohorts. Although prior BPA made PEA more challenging and increased select post-operative complications, it is not a contraindication for successful PEA.
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BibTeX
@article{yang2026pulmonary,
title = {{Pulmonary Endarterectomy After Balloon Pulmonary Angioplasty: A Single‐Center USA Experience}},
author = {Jenny Z Yang and Demosthenes G Papamatheakis and Kim M Kerr and Timothy M Fernandes and David S Poch and Mona Alotaibi and M Angela Bautista and Nick H Kim and Michael M Madani},
journal = {Pulmonary circulation},
year = {2026},
month = oct,
doi = {10.1002/pul2.70445},
url = {https://europepmc.org/article/PMC/PMC13717601},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Pulmonary Endarterectomy After Balloon Pulmonary Angioplasty: A Single‐Center USA Experience
AU - Jenny Z Yang
AU - Demosthenes G Papamatheakis
AU - Kim M Kerr
AU - Timothy M Fernandes
AU - David S Poch
AU - Mona Alotaibi
AU - M Angela Bautista
AU - Nick H Kim
AU - Michael M Madani
PY - 2026
DA - 2026/10/01
JO - Pulmonary circulation
DO - 10.1002/pul2.70445
UR - https://europepmc.org/article/PMC/PMC13717601
AB - Pulmonary endarterectomy (PEA) is the treatment of choice for operable chronic thromboembolic pulmonary hypertension (CTEPH), while balloon pulmonary angioplasty (BPA) is reserved for inoperable disease. However, operability is subjective and there are patients who may undergo BPA prior to PEA. It is not clear if prior BPA affects PEA outcomes. We present a series of patients from a single, high-volume, referral center who underwent PEA after prior BPA. CTEPH patients who underwent BPA prior to undergoing PEA at the University of California, San Diego between January 2013 and July 2025 were included. Post-PEA outcomes were compared to all PEA patients who did not have prior BPA from the year 2022. Twenty-one patients were identified. Average number of BPA sessions prior to PEA was 3.4 ± 2.1. The most common reason for initial BPA was distal disease deemed inoperable (43%). Average total circulatory arrest time was 61.5 ± 21.8 min, compared to 47.9 ± 19.3 min (p = 0.003) in the control PEA cases (n = 188). Post-operatively, the PEA after BPA cohort had longer ventilator days (p < 0.001), ICU days (p = 0.022) and post-operative length of stay (LOS) (p < 0.001); there were also higher rates of post-operative bleeding (p < 0.001) requiring transfusions (p = 0.033) and return to the operating room (p = 0.008). There was one death related to prior BPA complications despite adequate endarterectomy with improved hemodynamics. There was similar hemodynamic improvement post-operatively in both cohorts. Although prior BPA made PEA more challenging and increased select post-operative complications, it is not a contraindication for successful PEA.
SN - 2045-8932
SN - 2045-8940
ER -