Pulmonary Endarterectomy and Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension　― Similar Effects on Health-Related Quality of Life ―

Abstract

balloon pulmonary angioplasty (BPA) was introduced, which had similarly beneficial effects on hemodynamics, exercise tolerance, and prognosis in patients with inoperable or surgically inaccessible disease. 7-12 In spite of the progress in therapeutic options, some patients who have undergone PEA or BPA still had residual symptoms. 13,14 Health-related quality of life (HRQOL) measurement is a subjective outcome that represents disease impact on a person's function and wellbeing, and can be altered by disease treatment. 15,16 Beyond objective outcomes such as C hronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease characterized by fibrothrombotic obstructions of the pulmonary arteries (PA), resulting in increased pulmonary vascular resistance (PVR), pulmonary vascular remodeling and eventually leading to right ventricular failure. 1 The primary therapy for CTEPH has been pulmonary endarterectomy (PEA), 2 which contributes to better hemodynamics, oxygenation, exercise capacity, and prognosis. 3,4 CTEPH prognosis had been poor until the development of PEA. 5,6 Subsequently,

Quality of life and functional status after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: A Swedish single‐center study

“…The most affected domains were role physical and physical functioning (Figure 1 ). The RAND‐36 scores from our study are compared with those in three other studies 12 , 17 , 18 in Figure S1 .…”

“…Previous studies reported similar patterns of improvement in 6MWD after PEA for CTEPH. 13 , 18 In the UK cohort, the mean 6MWD pre‐PEA was 309 m and increased to 366 m 1‐year post‐PEA. 13 In the Japanese study, the mean 6MWD improved from 281 m preoperatively to 372 m postoperatively, although the improvement was not statistically significant.…”

“…A study in Japan investigated QOL before and after PEA or BPA for CTEPH. 18 The SF‐36 was completed by 39 patients ( n = 15 for PEA, n = 24 for BPA) before and after treatment. Significant differences in baseline characteristics were observed between the groups.…”

“… 12 In contrast, health‐related QOL measured with the SF‐36 was low across all domains in the Japanese study. 18 One reasonable explanation could be the differences in follow‐up time after surgery. The follow‐up time in the Japanese study was short (4 months) whereas the remaining studies included a longer mean follow‐up time (approximately 3 years).…”

“…Study settings have been challenging given the rarity of the disease, small study sample sizes, and long study periods. 12 , 13 , 17 , 18 Moreover, a wide variety of approaches to assess functional status have been used, including the 6‐min walk test (6MWT), World Health Organization (WHO) functional class, and the New York Heart Association (NYHA) class. Various instruments have been used to evaluate QOL—the EQ‐5D, the Short Form‐36/RAND 36‐Item Health Survey (RAND‐36), the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), and the Borg dyspnea score—making a comparison of studies difficult.…”