Efficacy and Safety of Bronchial Artery Embolization on Hemoptysis in Chronic Thromboembolic Pulmonary Hypertension: A Pilot Prospective Cohort Study

Objectives: Managing hemoptysis in chronic thromboembolic pulmonary hypertension can be challenging due to the difficulties in maintaining coagulation homeostasis in affected patients. In this study, we evaluated the efficacy and safety of bronchial artery embolization in treating hemoptysis in chronic thromboembolic pulmonary hypertension patients. Design: Pilot, prospective cohort study. Setting: A large respiratory medical institute. Patients: From January 1, 2012, to December 31, 2017, hospitalized chronic thromboembolic pulmonary hypertension patients were eligible for inclusion. Patients with pulmonary hypertension caused by other conditions, or who failed to participate in the follow-up were excluded. Interventions: Hemoptysis in chronic thromboembolic pulmonary hypertension patients was treated with or without bronchial artery embolization based on whether the bleeding could be stopped with medication alone and patient willingness for bronchial artery embolization treatment. Measurements and Main Results: A total of 328 patients diagnosed with chronic thromboembolic pulmonary hypertension were consecutively collected, 317 patients were completed the follow-up. There were 15 chronic thromboembolic pulmonary hypertension patients with hemoptysis in total, and the occurrence rate of hemoptysis in chronic thromboembolic pulmonary hypertension patients was 4.7%. Among the hemoptysis chronic thromboembolic pulmonary hypertension patients, 10 (67%) underwent bronchial artery embolization, and five (33%) were treated with medication only. The median follow-up period for hemoptysis patients was 7.6 months. In patients underwent bronchial artery embolization treatment, oxygenation index and right heart function showed no significant difference between pre bronchial artery embolization and post bronchial artery embolization. Hemoptysis relapse (20% vs 80%; p = 0.025) and hemoptysis-related mortality (0% vs 40%; p = 0.032) were significantly lower, whereas the overall survival (90% vs 40%; p = 0.040) was higher in patients treated with bronchial artery embolization than in patients treated without bronchial artery embolization. Conclusions: Bronchial artery embolization procedure demonstrated effectiveness and safety to treat hemoptysis in chronic thromboembolic pulmonary hypertension patients at our center, but further controlled studies are needed before it can be considered as an effective therapy for these patients. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Dr. S. Yang had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. S. Yang, Wang, Kuang, Gong, and Ma are responsible for acquisition of the data. Drs. S. Yang and Liang are responsible for analysis and interpretation of the data. Drs. S. Yang and Y. Yang are responsible for the study concept and design. Drs. S. Yang, Y. Yang, and Huang are the guarantors of the article. Drs. S. Yang, Shen, Y. Yang, and Huang are responsible for drafting of the article and critical revision of the article for intellectual content. All authors have provided final approval of the version to be published. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/29S62lw). Dr. Y. Yang received other support from National Science and Technology Pillar Program in the Twelfth Five-year Plan Period (2011BAI11B17), National Key Research and Development Program of China (2016YFC1304402), and National Natural Science Foundation of China (31670928). Dr. Huang received other support from National Science and Technology Pillar Program in the Twelfth Five-year Plan Period (2012BAI05B00, 2013BAI09B10), National Key Research and Development Program of China (2016YFC0901102), and National Natural Science Foundation of China (81470238). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: yyh1031@sina.com; kewuhuang@126.com Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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