Riociguat and balloon pulmonary angioplasty improve prognosis in patients with inoperable chronic thromboembolic pulmonary Hypertension

Wiedenroth, Christoph B.; Rolf, Andreas; Steinhaus, Kristin; Adameit, Miriam S.D.; Kriechbaum, Steffen; Haas, Moritz; Roller, Fritz; Hamm, Christian W.; Ghofrani, Hossein‐Ardeschir; Mayer, Eckhard; Breithecker, Andreas; Guth, Stefan; Liebetrau, Christoph

doi:10.1016/j.healun.2022.08.011

Cited by 28 publications

(11 citation statements)

References 28 publications

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“…However, comparisons of historical cohorts of inoperable CTEPH patients with patients treated by BPA have shown a significant and positive effect of BPA on the survival. 86 87 These results should be mitigated by the fact that the introduction of BPA was concomitant with the introduction of riociguat.…”

Section: Resultsmentioning

confidence: 99%

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Monographic Issue on Pulmonary Hypertension: Medical and Interventional Treatment for Chronic Thromboembolic Pulmonary Hypertension

Delcroix,

Belge,

Maleux

et al. 2023

Semin Respir Crit Care Med

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism. The reasons why clots do not resorb are incompletely understood, but the result is partial or complete fibrothrombotic obstruction of pulmonary arteries. A secondary microvasculopathy aggravates the pulmonary hypertension (PH) as a consequence of high flow and shear stress in the nonoccluded arteries. The treatment of CTEPH has long been purely surgical, but many patients were inoperable because of inaccessible lesions or severe comorbidities. Alternatives were developed, including medical therapy and more recently balloon pulmonary angioplasty (BPA). Depending on the generation of the obstructed vessels, the treatment will be surgical, up to the (sub)segmental level, or by BPA for more distal vessels. PH drugs are used to treat the microvasculopathy. The current paper describes the therapeutic management of inoperable patients: the medical approach with PH drugs used in mono- or combination therapy; the proper use of anticoagulants in CTEPH; the technique, indications, and results at short- and long-term of BPA; the multimodal approach for inoperable patients combining PH drugs and BPA; and the effects of rehabilitation. It shows the importance of a multidisciplinary approach to the disease.

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Section: Resultsmentioning

confidence: 99%

“…22 Recent cohorts have reported 3-year survival rates between 85 and 93% for inoperable patients. 86 87 Importantly, we have to remember that PEA, BPA, and sGC are not interchangeable, since they target different lesions: proximal disease, segmental/subsegmental disease, and microvasculopathy, respectively.…”

Section: Multimodal Approach For Inoperable Patientsmentioning

confidence: 99%

Monographic Issue on Pulmonary Hypertension: Medical and Interventional Treatment for Chronic Thromboembolic Pulmonary Hypertension

Delcroix,

Belge,

Maleux

et al. 2023

Semin Respir Crit Care Med

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“…Effective PH-targeted medical therapy and advances in BPA have resulted in improved outcomes for those patients with inoperable CTEPH. 39,40 Now that BPA has become an established treatment option and garnered a class I recommendation, 9 the dilemma has moved from debating if BPA is an appropriate treatment option to now choosing who are appropriate patients for BPA. There are no currently available precise guidelines or objective criteria on patient selection between BPA and PTE.…”

Section: Patient Selection For Bpamentioning

confidence: 99%

Balloon pulmonary angioplasty in the current era of CTEPH treatment: How did we get here?

Yang,

Poch,

Ang

et al. 2023

Pulm. circ.

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Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by persistent organized thromboembolic obstruction of the pulmonary arteries from incompletely resolved pulmonary embolism. The treatment of choice is pulmonary thromboendarterectomy (PTE) surgery and all patients should be evaluated for operability candidacy. Despite advancements in PTE technique allowing more segmental–subsegmental surgeries, up to a third of patients with CTEPH may still be considered inoperable. Over the past decade, there have been increasing treatment options for these inoperable CTEPH patients. Balloon pulmonary angioplasty (BPA) is a percutaneous‐based interventional treatment option for select CTEPH cases. Early BPA experiences were plagued by high complication rates, but further refinements in technique and equipment pioneered by Japan led to the worldwide spread and adoption of BPA. Multiple centers have shown that patients experience significant improvements in hemodynamics, quality of life, exercise capacity, and survival with BPA treatment. There remain many questions on best practices, but BPA has evolved into a pivotal cornerstone of CTEPH treatment.

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“…Erste Langzeitergebnisse sind vielversprechend, mit einem 3-bzw. 5-Jahres-Überleben von 92-95 % [26] und 88-90 % [28,29].…”

Section: Pulmonale Ballonangioplastieunclassified

Chronisch thromboembolische pulmonale Hypertonie

Adameit,

Wiedenroth,

Omlor

et al. 2023

Dtsch Med Wochenschr

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Die chronisch thromboembolische pulmonale Hypertonie (CTEPH) ist eine seltene Erkrankung, aber gut behandelbare Spätfolge nach einer akuten Lungenembolie. Daher wird eine Nachuntersuchung nach einer ausreichenden Antikoagulation von mindestens 3 Monaten empfohlen. Es stehen 3 Behandlungsmethoden zur Verfügung: die pulmonale Endarteriektomie, die pulmonale Ballonangioplastie und Medikamente, die auf die pulmonale Hypertonie wirken. Die Entscheidung über die Behandlung sollte von einem erfahrenen multidisziplinären Team in spezialisierten CTEPH-Zentren getroffen werden.

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Riociguat and balloon pulmonary angioplasty improve prognosis in patients with inoperable chronic thromboembolic pulmonary Hypertension

Cited by 28 publications

References 28 publications

Monographic Issue on Pulmonary Hypertension: Medical and Interventional Treatment for Chronic Thromboembolic Pulmonary Hypertension

Monographic Issue on Pulmonary Hypertension: Medical and Interventional Treatment for Chronic Thromboembolic Pulmonary Hypertension

Balloon pulmonary angioplasty in the current era of CTEPH treatment: How did we get here?

Chronisch thromboembolische pulmonale Hypertonie

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