Implementation of a New Programme for the Surgical Treatment of CTEPH in the Czech Republic - Pulmonary Endarterectomy

Lindner, Jaroslav; Jansa, Pavel; Kunstýř, Jan; Mayer, Eckhard; Bláha, J; Paleček, Tomáš; Aschermann, Michael; Grus, Tomáš; Ambrož, David; Tosovský, J; Vítková, Ivana

doi:10.1055/s-2006-924465

Cited by 11 publications

(3 citation statements)

References 12 publications

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“…The surgical technique developed by Daily and Jamieson 13 , 14 was used with some modifications. 15 Pulmonary endarterectomy surgery was performed in hypothermic circulatory arrest. An obstructive fibrous material from the pulmonary arteries was removed.…”

Section: Methodsmentioning

confidence: 99%

Atrial fibrillation and atrial tachycardia in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy

Havránek

Fingrová

Ambrož

et al. 2020

European Heart Journal Supplements

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Atrial fibrillation (AF) and atrial tachycardia (AT) are frequently observed in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who were treated with pulmonary endarterectomy (PEA). Their prevalence and impact on prognosis of patients are not known. We analysed the prevalence of AF/AT and the clinical outcome in 197 patients with CTEPH treated with PEA (median age 62; interquartile range 53–68 years; 62% males). The prevalence of AF/AT was 29% (57 patients). Compared to patients without arrhythmia, the subjects with AF/AT were older [60 (50–67) vs. 62 (57–70) years], manifested an increased size of the left atrium [39 (35–44) vs. 45 (40–50) mm], had a reduced 6-min walking distance [411 (321–506) vs. 340 (254–460) m], and higher pulmonary artery systolic pressure after PEA [38 (30–47) vs. 45 (38–71) mmHg], all results with P-value <0.05. During the follow-up with a median 4.2 (1.6–6.3) years, 45 (23%) patients died. In a multivariate Cox regression model only the male gender [hazard ratio (HR) 2.27, 95% confidence interval (CI) 1.15–4.50], a reduced 6-min walking distance (HR 3.67, 95% CI 1.74–7.73), and an increased New York Heart Association class (HR 8.56, 95% CI 4.17–17.60) were associated with mortality (P < 0.05). The prevalence of AF/AT in patients with CTEPH treated with PEA is high. Arrhythmias are associated with reduced functional capacity but not with mortality.

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Section: Methodsmentioning

confidence: 99%

Atrial fibrillation and atrial tachycardia in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy

Havránek

Fingrová

Ambrož

et al. 2020

European Heart Journal Supplements

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“…This national coverage allows the collection of comprehensive data on all CTEPH patients in the country. The only treatment option available to patients with CTEPH in the Czech Republic was PEA (introduced 2004) 24 until BPA was introduced in 2013 (with routine use from 2017 onward), 25 and riociguat became commercially available in the Czech Republic in 2015. Off‐label use is not permitted in the Czech Republic, and unlicensed treatments are therefore only available through participation in clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of chronic thromboembolic pulmonary hypertension (CTEPH) in the Czech Republic

Jansa

Ambrož

Kuhn³

et al. 2022

Pulm. circ.

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This study investigated the epidemiology and survival outcomes of chronic thromboembolic pulmonary hypertension (CTEPH) in the Czech Republic, wherein pulmonary endarterectomy (PEA) surgery was the only targeted treatment option until 2015. This study included all consecutive adults newly diagnosed with CTEPH in the Czech Republic between 2003 and 2016. Incidence/prevalence rates were calculated using general population data extracted from the Institute of Health Information and Statistics of the Czech Republic. Kaplan–Meier estimates of survival from diagnosis until 2018 were calculated. Of a total of 453 patients observed, 236 (52.1%) underwent PEA (median time from diagnosis to PEA: 2.9 months) and 71 (34.1%) had residual pulmonary hypertension (PH) post‐PEA. CTEPH incidence rate (95% confidence interval [CI]) between 2006 and 2016 was 4.47 (4.05; 4.91) patients per million (ppm) per year, and the prevalence (95% CI) was 37.43 (33.46; 41.73) ppm in 2016. The rate of CTEPH‐related hospitalizations (95% CI) per 100 person‐years was 24.4 (22.1; 26.9) for operated patients and 34.2 (30.9; 37.7) for not‐operated patients. Median overall survival (95% CI) for all patients from CTEPH diagnosis was 11.2 (9.4; not reached) years. Five‐year survival probability (95% CI) was 95.3% (89.9; 97.9) for operated patients without residual PH, 86.3% (75.3; 92.7) for operated patients with residual PH and 61.2% (54.0; 67.6) for not‐operated patients. This study reported epidemiological estimates of CTEPH in the Czech Republic consistent with estimates from other national systematic registries; and indicates an unmet medical need in not‐operated patients and operated patients with residual PH.

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“…In the Czech Republic, complex CTEPH management has been centralized at the Center of Pulmonary Hypertension in the General University Hospital in Prague [17]. Between 2003 and 2019, 623 patients with CTEPH had been diagnosed and 360 PEA procedures performed.…”

Section: Introductionmentioning

confidence: 99%

Balloon Pulmonary Angioplasty in Patients with Chronic Thromboembolic Pulmonary Hypertension: Impact on Clinical and Hemodynamic Parameters, Quality of Life and Risk Profile

Jansa

Heller

Svoboda

et al. 2020

JCM

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Balloon pulmonary angioplasty (BPA) is a novel treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are not eligible for pulmonary endarterectomy (PEA) or suffer from persistent pulmonary hypertension after PEA. The aim of this study was to evaluate the real-life efficacy and safety of BPA in a consecutive group of patients who were diagnosed and treated in the national referral center for CTEPH in the Czech Republic. Here we report data from 160 BPA procedures performed in 64 patients. Efficacy analysis was performed in the subgroup of 25 patients who completed BPA series. Significant improvements were observed in New York Heart Association functional class (4% to 79% in I/II, p < 0.001), 6 min walking test distance (+54.3 m, p < 0.001), risk profile (15.8% to 68.5% with presence of 2/3 low risk criteria, p < 0.001), pulmonary artery mean pressure (−18%, p < 0.001), pulmonary vascular resistance (−32%, p < 0.001), stroke volume (+17%, p = 0.011) and quality of life (+37% in assessment of overall health status by a patient, p < 0.001). We observed 1 fatal periprocedural complication (1.6% of all 64 patients) and 19 BPA-related non-fatal complications (11.9% of all 160 interventions) that predominantly included hemoptysis (10.0% of all sessions). Overall survival at 12 months was 94.6%.

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Implementation of a New Programme for the Surgical Treatment of CTEPH in the Czech Republic - Pulmonary Endarterectomy

Cited by 11 publications

References 12 publications

Atrial fibrillation and atrial tachycardia in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy

Atrial fibrillation and atrial tachycardia in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy

Epidemiology of chronic thromboembolic pulmonary hypertension (CTEPH) in the Czech Republic

Balloon Pulmonary Angioplasty in Patients with Chronic Thromboembolic Pulmonary Hypertension: Impact on Clinical and Hemodynamic Parameters, Quality of Life and Risk Profile

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