Long-term outcomes of surgery for chronic thromboembolic pulmonary hypertension compared with medical therapy at a single Korean center

Abstract

Background/AimsPulmonary endarterectomy (PEA) is the gold standard for treating chronic thromboembolic pulmonary hypertension (CTEPH) in Western countries. The aim of this study was to investigate the long-term outcomes of performing PEA on CTEPH patients in comparison with medical therapy at a single Korean center.MethodsThis retrospective study included 88 CTEPH patients. These patients were classified into the PEA group (n = 37) or non-PEA group (i.e., medical therapy; n = 51). The clinical characteristics, hemodynamic data, and long-term survival rates were compared. Independent prognostic factors for CTEPH were also investigated.ResultsCTEPH was not associated with either gender, and the mean age at diagnosis was 53.3 ± 13.7 years. Echocardiography revealed that the mean peak velocity of the tricuspid regurgitation jet was 4.2 ± 0.7 m/sec and the mean pulmonary arterial pressure was 51.7 ± 15.1 mmHg. The PEA and non-PEA groups demonstrated no significant differences, except in terms of the right ventricular end-diastolic diameter. The survival rates of the PEA group were significantly higher than the non-PEA group at 1, 3, 5, and 10 years (p = 0.032). Multivariate analyses indicated that World Health Organization class IV and PEA were significant predictors of poorer and better outcomes, respectively.ConclusionsPEA demonstrates more favorable effects on long-term survival than medical therapy in Korean CTEPH patients who were considered operable.

Life expectancy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a Swedish single‐center study

“…In comparison, the prognosis for inoperable CTEPH is discouraging with a 3-year survival of 70% according to the European CTEPH registry, 19 a 5-year survival in Sweden of about 50%, 5 and a 10-year survival at only 40% in a Korean population. 20 Similar results were published by Quadery et al, who reported a five-year survival between 53% and 59% in inoperable patients. 21 Patients undergoing PEA at dedicated high-volume centers have excellent long-term survival with 5-year survival between 79% and 82% and 10-year survival between 72% and 75%.…”

Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review

“…The current systematic review included nine studies reporting ten-year survival, which ranged from 62% to 86.1% with a median of 75% (8,19,22,(25)(26)(27)(28)43,64). Four studies reported 15-year survival: three reported rates between 55% to 59% and Gan et al reported fifteenyear survival of 29.6% in those with residual pulmonary hypertension compared to 91% in those without residual hypertension (18,27,28,64). No studies reported twentyyear survival.…”

“…Residual pulmonary hypertension was reported in fifteen of the included studies, rates of which ranged from 8.2% to 44.5% (9,23,24,26,30,31,40,44,45,46,49,55,64,66,71). However, it is worth noting that not all studies used the same definition for residual pulmonary hypertension and that many did not explicitly state a defined threshold for residual pulmonary hypertension.…”