Clinical Outcomes of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: A Retrospective Cohort Study From a Latin American Care Center.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a distinct subtype of pulmonary hypertension arising from persistent major pulmonary artery obstruction after pulmonary embolism. Pulmonary endarterectomy (PEA) remains the standard of care, but up to 40% of patients in European and US registries are inoperable; balloon pulmonary angioplasty (BPA) has emerged as a more accessible interventional modality for suitable patients. This retrospective single-center cohort study evaluated functional improvement, hemodynamic response, and mortality in patients with CTEPH ineligible for PEA who underwent BPA at a Colombian institution (May 2022-October 2025). Risk was stratified using COMPERA 2.0. The primary outcome was improvement of at least one New York Heart Association (NYHA) functional class; secondary outcomes were change in mean pulmonary arterial pressure (mPAP) and all-cause mortality during follow-up. Of 33 patients (median age 63 years; 70% female), 5 (15.1%) were high risk at baseline, 16 (48.4%) intermediate-high, 10 (30.3%) intermediate-low, and 2 (6%) low risk. After BPA, 19 patients (58%) improved NYHA class (95% CI, 39.2%-74.5%), and mPAP fell from 60 (IQR 50-68) to 40 mmHg (IQR 37-48) after a median of three sessions (IQR 2-4) (mean paired reduction 14.05 mmHg, 95% credible interval 9.81-18.07; Hedges' g = 1.22, 95% CI 0.77-1.66). Two deaths (6.0%) occurred, both in high-risk patients. BPA improved NYHA class and pulmonary hemodynamics in severe, inoperable CTEPH, with a low complication rate despite advanced baseline disease. COMPERA 2.0 stratified baseline severity but did not predict the magnitude of hemodynamic response to BPA, consistent with the mechanical nature of the disease.