Initiating a Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Endarterectomy Program Based on a Single Center Experience in Lebanon

Abstract

Purpose In 2018, the American University of Beirut Medical Center established the first multidisciplinary Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Endarterectomy program in Lebanon. The study describes the challenges faced in establishing the program and in improving patient referral, evaluation, and perioperative care. Methods The program establishment including the preparation phase, clinical evaluation, and team education is discussed. The implementation of the flow of patients referred to the program was established. Education regarding diagnosis and referral were provided to physicians in the community. The initial experience is described in a retrospective analysis of 4 consecutive patients who were diagnosed with CTEPH and underwent PEA. Results Four patients were diagnosed with CTEPH had PEA performed. The mean age of patients was 64 years. The average CPB and total circulatory arrest times were 244 and 23.9 minutes per side, respectively. No mortalities were encountered perio-operatively. All patients reported significant improvement in functional capacity from NYHA III and IV to a NYHA class of I with an average PASP decrease of 59.5 ± 19.7 mmHg and mPAP drop by 30.2 ± 16.3 mmHg. Conclusion The launch of the first CTEPH and PEA program in Lebanon, with a clear framework, coupled with good surgical outcomes is very encouraging. The program offers a curative solution for CTEPH patients in the region. A clear referral process and an increase in disease and treatment awareness in the community are crucial to the future success of the program, offering a definitive treatment, and avoiding delays to surgery.

Chronic Thromboembolic Pulmonary Hypertension: An Observational Study

“…The functional class NYHA at diagnosis resulted more frequently in III-IV and this underlines the literature data; probably due to the long median interval of time often required for diagnosis, approximately 70% of patients with CTEPH showed signs of right heart failure, hypoxemia or hypocapnic respiratory failure and elevated plasma BNP values [2][3][4][69][70][71][72][73]. In accordance with the data reported in the literature, the results of this study confirm the fundamental role of pulmonary endarterectomy (PEA) as the treatment of choice for CTEPH, having demonstrated its effectiveness in significantly improving the clinical, functional and hemodynamic situation in PEA patients [48][49][50].…”

Cardiothoracic Anesthesiology: Novel Milestone and Renewed Opportunities

“…Similarly, Osman et al present their initial experience establishing a specialized center in Lebanon for CTEPH therapy. 9 The authors must be congratulated on their successful endeavor as CTEPH surgery remains localized to only a few highly specialized centers, even in the United States. However, diligence must be exercised to differentiate initiation vs the center of excellence status.…”

“…Cardiothoracic anesthesiologists hold that unique position, as opined by the authors.Similarly, Osman et al present their initial experience establishing a specialized center in Lebanon for CTEPH therapy. 9 The authors must be congratulated on their successful endeavor as CTEPH surgery remains localized to only…”