Combined Balloon Pulmonary Angioplasty and Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension

Introduction. The combination of pulmonary thromboendarterectomy (PEA) and balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is increasingly performing for the treatment. Objective: To present our experience of step-by-step surgical treatment of patients with CTEPH and severe pulmonary hypertension (PH). Methods: Retrospective analysis of two-stage treatment 27 patients from January 2019 to March 2024 was conducted. BPA as the first stage of treatment was performed to improve hemodynamic data and reduce surgical risk. After 3 - 4 months, the same patients underwent PEA. Results: The median age at diagnosis was 47 (IQR 15 - 78) years, 51.9% males and 48.1% females. Due to New York Heart Association (NYHA), 1 (3.7%) patient belonged to class II, 19 (70.4%) to class III and 7 (25.9%) to class IV. After BPA the mean pulmonary artery pressure (mPAP, mmHg) and pulmonary vascular resistance (PVR, dynes*s*cm5) significantly decreased (66.2 ± 9.5 vs 53.7 ± 9.5, P *s*cm5) also significantly decreased (51.3 ± 5.5 vs 27.6 ± 4.5, P Conclusion: A staged approach may be an effective surgical tactic in patients with CTEPH and severe PH. However, it is necessary to identify criteria for patient selection, and procedural efficacy.