Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: Results from an international prospective registry

Mayer, Eckhard; Jenkins, David P.; Lindner, Jaroslav; D’Armini, Andrea Maria; Kloek, Jaap J.; Meyns, Bart; Ilkjær, Lars Bo; Klepetko, Walter; Delcroix, Marion; Lang, Irene M.; Pepke‐Zaba, Joanna; Simonneau, Gérald; Dartevelle, Philippe

doi:10.1016/j.jtcvs.2010.11.024

Cited by 634 publications

(679 citation statements)

References 25 publications

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“…Until recently, surgical pulmonary endarterectomy (PEA) performed under deep hypothermia with periods of total cardiac arrest was the only effective treatment for chronic thromboembolic pulmonary hypertension (CTEPH) [1]. Despite the increasing expertise of dedicated surgical teams, a significant proportion of patients with CTEPH do not qualify for PEA [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Kurzyna¹,

Darocha²,

Pietura³

et al. 2017

Kardiol Pol

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A b s t r a c t Background and aim:To assess the safety and efficacy of a refined balloon pulmonary angioplasty (BPA) strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods: There were 157 BPA sessions performed in 56 CTEPH patients (47 non-operable, nine after pulmonary endarterectomy; aged 58.6 ± 17.9 years; 28 females) with severely impaired pulmonary haemodynamics (mean pulmonary artery pressure [mPAP]: 51.3 ± 12.2 mm Hg, pulmonary vascular resistance [PVR]: 10.1 ± 3.9 Wood Units). The first 50 sessions aimed to recanalise chronic occlusions and prevent reocclusion with aggressive anticoagulation. The next 107 sessions aimed to relieve "web" and "ring" lesions using reduced tip load guidewires and less intensive anticoagulation.Results: There was significant reduction in haemoptysis (22% vs. 7%, p = 0.01), vessel injury (30% vs. 13%, p = 0.01), and reperfusion pulmonary injuries (22% vs. 4%, p = 0.01) after changing the BPA strategy. Mortality at 14 days was also reduced (6% vs. 0%; p = 0.05). The cumulative survival rate was 94.6% at 24 months after the first BPA, which was more favourable than medically treated historic controls. In the 31 patients with > 3 BPA sessions, there was significant reduction of PVR (10.3 ± 3.7 vs. 5.9 ± 2.8 Wood Units; p = 0.01), mPAP (50.7 ± 10.8 vs. 35.6 ± 9.3 mm Hg; p = 0.01) and improvement in World Health Organisation functional class (3.19 ± 0.48 vs. 1.97 ± 0.80; p < 0.001).Conclusions: Balloon pulmonary angioplasty improves haemodynamics and outcome but requires refined strategy to limit early complication rate.

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Section: Introductionmentioning

confidence: 99%

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Kurzyna¹,

Darocha²,

Pietura³

et al. 2017

Kardiol Pol

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“…Without being treated, the prognosis is so poor that a 5‐year survival rate in patients with a mean pulmonary artery pressure (mPAP) >50 mm Hg is 10% 6. Pulmonary endarterectomy (PEA) is a gold standard therapy7, 8; however, PEA for organized thrombus located peripherally in subsegmental pulmonary arteries was less effective and had a high perioperative mortality rate 7, 9. Presently, balloon pulmonary angioplasty (BPA) can be recommended as an established treatment for nonoperable CTEPH patients 10, 11, 12, 13, 14, 15, 16…”

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confidence: 99%

“…Residual pulmonary hypertension (PH) after PEA occurs in ≈10% to 35% of patients4, 8, 17, 18, 19 and is the issue to be solved. It can cause persistent symptoms.…”

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confidence: 99%

Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Yanaka

Nakayama

Shinke

et al. 2018

JAHA

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BackgroundResidual symptoms after pulmonary endarterectomy (PEA) remain as the clinical issues to be solved. Additional balloon pulmonary angioplasty (BPA) after PEA showed its efficacy with symptoms in a case series, although long‐term spontaneous recovery of exercise ability after PEA was also reported. However, no studies have validated the clinical efficacy of additional BPA by directly comparing PEA with and without BPA. The aim of this study was to retrospectively evaluate the efficacy of additional BPA as a sequential hybrid therapy for chronic thromboembolic pulmonary hypertension after PEA.Methods and ResultsAmong 44 patients with chronic thromboembolic pulmonary hypertension, 20 patients had residual symptoms after PEA. Of those, 10 patients underwent additional BPA (hybrid group) and were compared with the other 10 patients, who were followed up without BPA (PEA group). The period from PEA to additional BPA was 7.3±2.3 months. In hybrid group, mean pulmonary arterial pressure was significantly improved by PEA (40.6±1.8 to 26.9±3.1 mm Hg, P=0.001) and improved further (to 16.7±1.8 mm Hg, P=0.002) with additional BPA, which resulted in remarkable improvement in World Health Organization (WHO) functional class (pre‐ to post‐BPA: class I/II/III/IV, 0/5/4/1 to 7/3/0/0; P<0.001). Compared with the PEA group at follow‐up, the hybrid group achieved better mean pulmonary arterial pressure (18.7±1.7 versus 30.2±3.2 mm Hg, P=0.008), WHO functional class (class I/II/III/IV, 7/3/0/0 versus 0/8/2/0; P=0.001), and 6‐minute walking distance (429±38 versus 319±22 m, P=0.028).ConclusionsA sequential hybrid strategy improved residual symptoms and exercise capacity compared with single‐PEA therapy.

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“…Surgical pulmonary endarterectomy (PEA) is considered to be the only curative treatment for CTEPH [11,12]. PEA significantly reduces the pulmonary vascular pressures and resistances.…”

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confidence: 99%

“…Results from an international prospective registry yielded an in-hospital mortality of about 5 %, and a documented 1-year mortality of 7 %. Furthermore, PEA has a high long-term survival rate of 84 % [12]. Surgical operability is clearly based on a center-specific assessment that is subject to large center-to-center variations.…”

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confidence: 99%

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) – Potential Role of Multidetector-Row CT (MD-CT) and MR Imaging in the Diagnosis and Differential Diagnosis of the Disease

Wirth

Brüggemann

Bostel

et al. 2014

Fortschr Röntgenstr

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Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as pulmonary hypertension (resting mean pulmonary arterial pressure of 25?mm Hg or more determined at right heart catheterization) with persistent pulmonary perfusion defects. It is a rare, but underdiagnosed disease with estimated incidences ranging from 0.5?% to 3.8?% of patients after an acute pulmonary embolism (PE), and in up to 10?% of those with a history of recurrent PE. CTEPH is the only form of pulmonary hypertension that can be surgically treated leading to normalization of pulmonary hemodynamics and exercise capacity in the vast majority of patients. The challenges for imaging in patients with suspected CTEPH are fourfold: the imaging modality should have a high diagnostic accuracy with regard to the presence of CTEPH and allow for differential diagnosis. It should enable detection of patients suitable for PEA with great certainty, and allow for quantification of PH by measuring pulmonary hemodynamics (mPAP and PVR), and finally, it can be used for therapy monitoring. This overview tries to elucidate the potential role of ECG-gated multidetector CT pulmonary angiography (MD-CTPA) and MR imaging, and summarizes the most important results that have been achieved so far. Generally speaking, ECG-gated MD-CTPA is superior to MR in the assessment of parenchymal and vascular pathologies of the lung, and allows for the assessment of cardiac structures. The implementation of iodine maps as a surrogate for lung perfusion enables functional assessment of lung perfusion by CT. MR imaging is the reference standard for the assessment of right heart function and lung perfusion, the latter delineating typical wedge-shaped perfusion defects in patients with CTEPH. New developments show that with MR techniques, an estimation of hemodynamic parameters like mean pulmonary arterial pressure and pulmonary vascular resistance will be possible. CT and MR imaging should be considered as complementary investigations providing comprehensive information in patients with CTEPH. Citation Format: ??Wirth G, Br?ggemann K, Bostel T et?al. Chronic Thromboembolic Pulmonary Hypertension (CTEPH) ? Potential Role of Multidetector-Row CT (MD-CT) and MR Imaging in the Diagnosis and Differential Diagnosis of the Disease. Fortschr R?ntgenstr 2014; 186: 751???761

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Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: Results from an international prospective registry

Abstract: Pulmonary endarterectomy is associated with a low in-hospital mortality rate and improvements in hemodynamics and exercise capacity.

Cited by 634 publications

References 25 publications

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience

Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) – Potential Role of Multidetector-Row CT (MD-CT) and MR Imaging in the Diagnosis and Differential Diagnosis of the Disease

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