Abstract
BackgroundPulmonary endarterectomy (PEA) is established for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Recently, percutaneous transluminal pulmonary angioplasty (PTPA) has been added for peripheral-type CTEPH, whose lesions exist in segmental, subsegmental, and more distal pulmonary arteries. A shift in clinical practice of interventional therapies occurred in 2009 (first mainly PEA, later PTPA). We examined the latest clinical outcomes of patients with CTEPH.Methods and ResultsThis study retrospectively included 136 patients with CTEPH. Twenty-nine were treated only with drug (Drug-group), and the other 107 underwent interventional therapies (Interventions-group) (39 underwent PEA [PEA-group] and 68 underwent PTPA [PTPA-group]). Total 213 PTPA sessions (failures, 0%; mortality rate, 1.47%) was performed in the PTPA-group (complications: reperfusion pulmonary edema, 7.0%; hemosputum or hemoptysis, 5.6%; vessel dissection, 2.3%; wiring perforation, 0.9%). Although baseline hemodynamic parameters were significantly more severe in the Interventions-group, the outcome after the diagnosis was much better in the Interventions-group than in the Drug-group (98% vs. 64% 5-year survival, p<0.0001). Hemodynamic improvement in the PEA-group was a 46% decrease in mean pulmonary arterial pressure (PAP) and a 49% decrease in total pulmonary resistance (TPR) (follow-up period; 74.7±32.3 months), while those in the PTPA-group were a 40% decrease in mean PAP and a 49% decrease in TPR (follow-up period; 17.4±9.3 months). The 2-year survival rate in the Drug-group was 82.0%, and the 2-year survival rate, occurrence of right heart failure, and re-vascularization rate in the PEA-group were 97.4%, 2.6%, and 2.8%, and those in the PTPA-group were 98.5%, 2.9%, and 2.9%, respectively.ConclusionThe patients who underwent interventional therapies had better results than those treated only with drugs. The availability of both of these operative and catheter-based interventional therapies leads us to expect the dawn of a new era of therapeutic strategies for CTEPH.
Highlights
Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive and life-threatening disease in which chronic thromboembolism in the pulmonary arteries leads to pulmonary hypertension and right heart failure [1,2,3,4,5,6,7,8,9]
The patients who underwent interventional therapies had better results than those treated only with drugs. The availability of both of these operative and catheter-based interventional therapies leads us to expect the dawn of a new era of therapeutic strategies for chronic thromboembolic pulmonary hypertension (CTEPH)
Gender, clinical severity according to NYHA functional class, exercise capacity according to 6MWD, and the ratio of administration of specific pulmonary vasodilators were not significantly different between patients in the Drug-group and patients treated with interventional therapy, pulmonary endarterectomy (PEA) and/or percutaneous transluminal pulmonary angioplasty (PTPA) (Interventions-group)
Summary
Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive and life-threatening disease in which chronic thromboembolism in the pulmonary arteries leads to pulmonary hypertension and right heart failure [1,2,3,4,5,6,7,8,9]. Feinstein et al suggested that balloon pulmonary angioplasty is feasible for the treatment of CTEPH [17], and in recent several years, our group and others have reported that repeated balloon pulmonary angioplasty, so-called percutaneous transluminal pulmonary angioplasty (PTPA), improved subjective symptoms and hemodynamic parameters in patients with peripheral-type CTEPH, whose thromboembolic lesions exist in segmental, subsegmental, and more distal pulmonary arteries. Residual pulmonary hypertension contributes to poor life expectancy in patients with CTEPH [18,19]. Pulmonary endarterectomy (PEA) is established for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Percutaneous transluminal pulmonary angioplasty (PTPA) has been added for peripheraltype CTEPH, whose lesions exist in segmental, subsegmental, and more distal pulmonary arteries. We examined the latest clinical outcomes of patients with CTEPH
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