Safety and Feasibility of Same-Day Discharge After Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: A Single-Center Retrospective Study

Abstract

Background

Balloon pulmonary angioplasty (BPA) is increasingly used for patients with inoperable or residual chronic thromboembolic pulmonary hypertension. Overnight observation is the current standard practice. We evaluated the safety and feasibility of same-day discharge (SDD) after BPA at a contemporary US referral center.

Methods

We retrospectively analyzed consecutive chronic thromboembolic pulmonary hypertension patients undergoing BPA between 2018 and 2024. SDD was defined as discharge on the calendar day of BPA. The primary outcome was 30-day readmission or mortality; secondary outcomes included BPA-related complications. Predictors of SDD were assessed using mixed-effects logistic regression.

Results

Seventy-seven patients underwent 262 BPA procedures; 89 (34%) were followed by SDD. Patients selected for SDD had higher baseline 6-minute walk distance (356 vs 270 m; P = .010). SDD procedures were shorter (89 vs 101 minutes; P < .001) and associated with lower mean pulmonary artery pressure (28.5 vs 34.9 mm Hg; P < .001). Overall, 30-day complication rates were low (6/262, 2.3%), with no periprocedural deaths. Thirty-day readmission rates were similar between SDD and non-SDD procedures (7.9% vs 4.0%; P = .43). In multivariable analysis, higher 6-minute walk distance (odds ratio [OR], 1.66 per 100 m; P = .026), device closure (OR, 6.33; P = .028), and larger balloon size (OR, 1.44 per mm; P = .037) were associated with SDD, whereas initial BPA session (OR, 0.13; P < .001) and longer procedure duration (OR, 0.66 per 10 minutes; P < .001) were associated with admission.

Conclusions

Among patients meeting prespecified institutional eligibility criteria, SDD after BPA was feasible and not associated with increased 30-day adverse events. Structured SDD pathways guided by reproducible selection criteria may optimize resource utilization as BPA volumes continue to grow.