Temporal Trends in Age Profile and Safety of Balloon Pulmonary Angioplasty for CTEPH

BACKGROUND: Balloon pulmonary angioplasty (BPA) techniques have been refined and increasingly adopted for chronic thromboembolic pulmonary hypertension. OBJECTIVES: This study aimed to evaluate the temporal trends in BPA safety, with a focus on outcomes in older patients. METHODS: Using the Japanese Cardiovascular Disease All-Case Registry (2013-2022), we retrospectively analyzed 14,429 BPA procedures performed on 3,700 patients (median age, 68 years). The study period was divided into early (2013-2017) and late (2018-2022) periods. Patient characteristics and major complication rates were evaluated for each period. Complications were defined as a composite of major adverse events occurring within 30 days: death, mechanical ventilation, extracorporeal membrane oxygenation, continuous hemodiafiltration, transfusion, cardiac tamponade, or surgery. RESULTS: Patients treated in the late period were older (P < 0.001). The complication rate decreased from 7.8% in the early period to 4.2% in the late period (P < 0.001). In multivariable analysis, the adjusted OR of complications was lower in the late period (OR: 0.411; 95% CI: 0.247-0.675). The adjusted complication risk decreased across all age categories in the late period. An age-dependent increase in the adjusted complication risk was observed across all periods (trend P = 0.002), significant in the early (trend P = 0.015) but not in the late (trend P = 0.085) period. CONCLUSIONS: BPA safety has improved over time. Despite higher complication risks in older patients, the narrowing gap with younger patients in recent years suggests that BPA is a safe and feasible option for this population.