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Canadian Journal of Cardiology

Shortening Hospital Stay Is Feasible and Safe in Patients With Chronic Thromboembolic Pulmonary Hypertension Treated With Balloon Pulmonary Angioplasty

Published:December 07, 2018DOI:https://doi.org/10.1016/j.cjca.2018.12.001

      Abstract

      Background

      There is no consensus on the length of hospital stay (LOHS) and post-interventional management after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We examined temporal trends with respect to LOHS and requirement for intensive care for BPA and their relationship with the incidence of BPA-related complications.

      Methods

      From November 2012 to September 2017, a total of 123 consecutive patients with CTEPH who underwent BPA were enrolled (age: 66.0 [54.0 to 74.0], World Health Organization [WHO] functional class II/III/IV; 27/88/8). Patients were divided for analysis into 3 groups according to the date of their first BPA: early-, middle-, and late-phase groups.

      Results

      Mean pulmonary arterial pressure decreased from 36.0 (29.0 to 45.0) to 20.0 (16.0 to 22.0) mm Hg after BPA (P < 0.001). The LOHS was 41.0 (31.0 to 54.0) days in total including all sessions and 6.6 (6.0 to 7.9) days/session. Despite no significant differences in age, baseline hemodynamics, and laboratory data among the 3 groups, there was a significant reduction in LOHS (7.9 [7.0 to 9.5], 6.5 [6.1 to 7.3], 6.0 [5.3 to 6.5] days/session, P < 0.001) and use of intensive/high care unit (100%, 93%, 46%, P < 0.001). The reduction in LOHS and intensive/high care unit use did not affect the occurrence of BPA-related complications.

      Conclusions

      Increasing experience with BPA was associated with a reduction in LOHS and the use of intensive/high care unit, but no change was noted in the rate of BPA-related complications. These findings suggest that the reduction in both LOHS and use of the intensive care unit for BPA is feasible and does not jeopardize the safety of the procedure.

      Résumé

      Introduction

      Il n'y a pas de consensus sur la durée du séjour hospitalier (DSH) et la gestion post-intervention après angioplastie pulmonaire par ballonnet (APB) chez les patients atteints d'hypertension pulmonaire thromboembolique chronique (HPTEC). Nous avons examiné les tendances temporelles en matière de DSH et les besoins en soins intensifs pour l’APB et leur relation avec l'incidence de complications liées l’APB.

      Méthodes

      Entre novembre 2012 et septembre 2017, un total de 123 patients successifs atteints d’HPTEC et traités par APB ont été inscrits (âge: 66,0 [54,0 à 74,0], classe fonctionnelle II/III/IV de l'Organisation mondiale de la Santé [OMS]; 27/88/8). Pour l’analyse, les patients ont été divisés en 3 groupes en fonction de la date de leur première APB : groupes de phase précoce, intermédiaire et avancée.

      Résultats

      La pression artérielle pulmonaire moyenne a diminué de 36,0 (29,0 à 45,0) à 20,0 (16,0 à 22,0) mm Hg après l’APB (P<0,001). La DSH était de 41,0 (31,0 à 54,0) jours, toutes séances confondues, et de 6,6 (6,0 à 7,9) jours/séance. Malgré l’absence de différence significative entre l’âge, les paramètres hémodynamiques de base et les données de laboratoire des 3 groupes, il y avait une réduction significative de la DSH (7,9 [7,0 à 9,5], 6,5 [6,1 à 7,3], 6,0 [5,3 à 6,5] jours/séances, P<0,001) et de l’utilisation d’unité de soins intensifs (100 %, 93 %, 46 %, P <0,001). La réduction de la DSH et de l'utilisation d’unités de soins intensifs n'a pas eu d'incidence sur le taux de complications liées à l’APB.

      Conclusions

      L'expérience accrue de l’APB était associée à une réduction de la DSH et à l'utilisation d'unités de soins intensifs, mais aucun changement n'a été observé dans le taux de complications liées à l’APB. Ces résultats suggèrent que la réduction à la fois de la DSH et de l'utilisation d'unité de soins intensifs pour l’APB est réalisable et ne compromet pas la sécurité de la procédure.
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