P183 Impact of patient choice on survival in patients with chronic thromboembolic pulmonary hypertension offered pulmonary endarterectomy

Abstract

IntroductionChronic thromboembolic pulmonary hypertension (CTEPH) is potentially curable by pulmonary endarterectomy (PEA). Despite this a significant proportion of patients offered PEA decline surgery.ObjectiveTo compare long term survival and prognostic indicators in patients with technically operable CTEPH who underwent PEA and those who declined surgery.MethodsData were collected for consecutive, treatment-naïve patients diagnosed with CTEPH between 2001 and 2014 identified from the ASPIRE-pulmonary-hypertension-registry.ResultsOf 588 patients with CTEPH, 368 patients were offered surgery. Seventy six percent (n=281) underwent PEA, 20% (n=72) declined surgery and 4% (n=15) were planned to undergo surgery. Five year survival was superior in patients undergoing PEA at 83% compared to patients who declined surgery at 56% (p=0.001, log-rank test). In patients who were offered surgery, mixed venous oxygen saturation (SvO2) (p=0.003), gas transfer (DLco) (p=0.042), history of coronary artery disease (p=0.031) and patient choice (declining surgery) (p<0.001) were independent predictors of mortality. For patients who declined surgery a median threshold of DLco 62%, right atrial pressure 11 mmHg, and SvO262% the positive and negative predictive values for 3 year survival were 31% and 100%, 32% and 95% and 30% and 97%, respectively.Abstract P183 Figure 1ConclusionIn a cohort of consecutive patients with CTEPH the long-term survival of patients undergoing PEA is excellent and superior to patients declining surgery and strongly favours surgical intervention in eligible patients. More work is required to understand factors influencing decision making in CTEPH and to ensure that patients are counselled and supported to make informed decisions.

A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension

“…In this base case grounded on a Dutch healthcare perspective, we have assumed a 60% proportion of cases undergoing PEA, whereas performing BPA was set at 15% [7,17,18]. The PAH targeted therapy group comprised 15% of total, and the remaining 10% received no treatment [7,17].…”

Multicenter Standardization of Phase‐Resolved Functional Lung MRI in Patients With Suspected Chronic Thromboembolic Pulmonary Hypertension

“…5 CTEPH is a life-threatening long-term complication of acute pulmonary embolism (PE). 6,7 The clinical outcomes can however be greatly improved if the disease is treated early enough mainly with a surgical approach named pulmonary endarterectomy (PEA) 8,9 or alternative interventions such as balloon pulmonary angioplasty and/or medical treatment in cases where surgery is not feasible. 10 Diagnosing CTEPH requires, among others, the detection of non-matched segmental and subsegmental perfusion deficits within the pulmonary arterial tree (ventilation-perfusion mismatch) due to chronic PEs.…”