Treatment of chronic thromboembolic pulmonary hypertension in a multidisciplinary team

Abstract

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) may be treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapy (MT). Assessment in a multidisciplinary team of experts (CTEPH team) is currently recommended for treatment decision making. The aim of the present study was to report the effects of such an interdisciplinary concept. Methods and results: A total of 160 patients were consulted by the CTEPH team between December 2015 and September 2018. Patient baseline characteristics, CTEPH team decisions and implementation rates of diagnostic and therapeutic procedures were analysed. Change in World Health Organization (WHO) functional class and survival rates were evaluated by treatment strategy. A total of 51 (32%) patients were assessed as operable and 109 (68%) were deemed inoperable. Thirty-one (61% of operable patients) underwent PEA. Patients treated with PEA, BPA(+MT) and MT alone were 50.9 ± 14.7, 62.9 ± 15.1 and 68.9 ± 12.7 years old, respectively. At the follow-up, PEA patients had the highest WHO functional class improvement. Patients treated with BPA(+MT) had significantly better survival than PEA (p = 0.04) and MT patients (p = 0.04; 2-year survival of 92%, 79% and 79%, respectively). Conclusions:The CTEPH team ensures that necessary diagnostic procedures are performed. A relatively low proportion of patients was assessed by the CTEPH team as operable and underwent surgery, which in survivors resulted in the best functional improvement. Although patients undergoing BPA(+MT) were older than patients treated with PEA, their survival was better than patients subjected to PEA or MT alone. The reviews of this paper are available via the supplemental material section.

Balloon Pulmonary Angioplasty in Technically Operable and Technically Inoperable Chronic Thromboembolic Pulmonary Hypertension

“…Significant improvement in both groups was also observed in terms of functional capacity and biochemical parameters. The 1-year and 3-year survival in the p-CTEPH group was achieved at the level of 94%, which contrasts with the 79% survival rate of the CTEPH patients treated solely with medical therapy reported previously [35].…”

Soluble ST2 as a Biomarker for Early Complications in Patients with Chronic Thromboembolic Pulmonary Hypertension Treated with Balloon Pulmonary Angioplasty

“…BPA is a promising treatment method for patients with inoperable CTEPH [ 4 ]. In the last few years, the data about the beneficial effects and technical improvements of the BPA strategy led to a high level of peri- and postprocedural safety [ 20 , 21 , 22 , 23 , 34 ]. Despite this, the assessment of biomarkers for heart failure, not only in monitoring treatment effects but also the periprocedural course and possible postprocedural complications, seems to be an important point in the entire therapeutic process of these patients.…”

Characteristics and outcomes of patients with chronic thromboembolic pulmonary hypertension in the era of modern therapeutic approaches: data from the Polish multicenter registry (BNP-PL)

“…All patients were categorized as operable or non-operable by one of two CTEPH teams. 36 The diagnosis of CTEPH was at the discretion of co-investigators who managed the enrolled patients in their centers. However, the diagnosis had to fulfill the criteria recommended by the ESC and ERS.…”