Perioperative management of patients with chronic thromboembolic pulmonary hypertension and transluminal balloon pulmonary angioplasty

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Abstract

Modern approaches to the treatment of patients with chronic thromboembolic pulmonary hypertension are based on a combination of pharmacotherapy and surgical methods. Transluminal balloon pulmonary angioplasty is a crucial interventional strategy, especially in patients who cannot undergo thromboendarterectomy or who experience residual pulmonary hypertension after surgery. Numerous studies have confirmed the high efficacy of transluminal balloon pulmonary angioplasty, demonstrating a significant reduction in pulmonary vascular resistance and pulmonary artery pressure. However, despite its proven therapeutic potential, the method is associated with the risk of serious complications. The most dangerous of these is lung ischemia-reperfusion injury, which can cause acute respiratory failure requiring mechanical ventilation or extracorporeal membrane oxygenation. Currently, preventive measures are being developed, including protocol improvements, stepwise dilation, use of intraoperative imaging, as well as preoperative administration of pulmonary hypertension-specific drugs. Effective and safe use of transluminal balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension requires strict patient selection, procedure performance in specialized centers, interdisciplinary decision-making, as well as readiness for timely diagnosis and management of complications in the early and late postoperative periods. Standardization of the procedure and development of algorithms aimed at reducing the risk of complications remain a promising direction.

 

About the authors

A. A. Klimenko

N.I. Pirogov Russian National Research Medical University (Pirogov University), Ministry of Health of Russia; N.I. Pirogov City Clinical Hospital No. 1, Moscow Healthcare Department

Email: saakyan.yuriy@gmail.com
ORCID iD: 0000-0002-7410-9784
Russian Federation, 1 Ostrovityanova St., Moscow 117513; 8 Leninskiy Prospekt, Moscow 119049

D. Yu. Andriyashkina

N.I. Pirogov Russian National Research Medical University (Pirogov University), Ministry of Health of Russia

Email: saakyan.yuriy@gmail.com
ORCID iD: 0000-0001-8266-6022
Russian Federation, 1 Ostrovityanova St., Moscow 117513

E. F. Makhnyr

N.I. Pirogov Russian National Research Medical University (Pirogov University), Ministry of Health of Russia; N.I. Pirogov City Clinical Hospital No. 1, Moscow Healthcare Department

Email: saakyan.yuriy@gmail.com
ORCID iD: 0000-0002-9255-8831
Russian Federation, 1 Ostrovityanova St., Moscow 117513; 8 Leninskiy Prospekt, Moscow 119049

Yu. M. Saakyan

N.I. Pirogov Russian National Research Medical University (Pirogov University), Ministry of Health of Russia

Author for correspondence.
Email: saakyan.yuriy@gmail.com
ORCID iD: 0000-0002-0457-8921
Russian Federation, 1 Ostrovityanova St., Moscow 117513

A. Yu. Tarantina

N.I. Pirogov City Clinical Hospital No. 1, Moscow Healthcare Department

Email: saakyan.yuriy@gmail.com
ORCID iD: 0000-0001-6528-9093
Russian Federation, 8 Leninskiy Prospekt, Moscow 119049

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