Transbronchial cryobiopsy is safe for patients with echocardiographic evidence of pulmonary hypertension: a blinded prospective cohort study

Introduction – Bleeding is the most concerning complication of transbronchial lung cryobiopsy (TBCB). Pulmonary hypertension (PH) is frequently treated as a relative contraindication to bronchoscopic biopsy because of presumed excess bleeding risk, yet TBCB specific data is limited. Methods – We conducted a prospective blinded cohort study including consecutive adult patients with interstitial lung disease (ILD) referred to TBCB. All participants underwent pre-procedure transthoracic echocardiography (TTE) with estimation of pulmonary artery systolic pressure (EPASP); bronchoscopists were blinded to TTE results. PH was defined as absent, mild (EPASP 37–50 mmHg) or moderate (51–70 mmHg). Severely elevated EPASP (>70 mmHg) was planned to trigger unblinding but did not occur. Primary outcomes were quantitative bleeding volume, measured by net suction volume, and clinically graded bleeding severity. Secondary outcomes included pneumothorax, hypoxemia, and hypotension. Results – A total of 74 patients were included; 19 patients met any PH definition (EPASP>36 mmHg). There was an insignificant age difference between any-PH and no-PH groups (66.6 ± 13.4 vs. 59.5 ± 13.2 years, p = 0.052), a slight male preponderance, and increased hypertension and diabetes rates in the any-PH group. There was no association between PH status and bleeding volume (Mann–Whitney-U, p = 0.54), nor across PH severity strata (Kruskal–Wallis, p = 0.52). This was further validated by multivariable log-linear regression. One hypoxemia event occurred; Pneumothorax occurred in 6.8%, with no association with PH (p = 0.51); no hypotension events were observed. Conclusion – TBCB is safe among patients with echocardiographic evidence of mild to moderate PH. These findings should be further studied, yet provide positive prospective evidence.