Are there real differences between the treatment for young and elderly patients with chronic thromboembolic pulmonary hypertension?

Abstract

Abstract Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable type of pulmonary hypertension, but it is poorly characterized in elderly patients. Purpose This study aimed to investigate the clinical characteristics, treatment strategy and survival of elderly patients with CTEPH. Methods All CTEPH patients evaluated at our institution between 2000 and 2018 were collected. They were divided into two groups according to 75th percentile of age. Thrombotic lesions were considered proximal when affecting the main pulmonary artery, lobular and proximal segmental arteries. All patients were discussed at a multidisciplinary team meeting. Pulmonary thromboendarterectomy (PTE) was the treatment of choice. Balloon pulmonary angioplasty (BPA) and vasodilator treatment were second-line strategies for those considered inoperable in view of unfavourable pulmonary vascular anatomy or comorbidities. As BPA program was started in our centre in 2013. Results 484 patients were included. Baseline distinctive features are described in table 1. Medical therapy alone was more frequently considered in elderly patients. However, when adjusted for thrombotic lesions location, there were no differences in treatment strategies (p<0.0005). Mortality was higher in the elderly patients group (p<0.00005), with differences in cumulative survival distribution (p<0.00005). This differences was maintained even after adjusted analysis for thrombotic lesions location (p=0.01) (picture 1). Conclusion CTEPH in elderly patients shows more incidence of distal involvement, which limits the number of patients suitable for PTE. After adjusted for the location of the injuries, treatment strategies were similar between both groups. Nevertheless, mortality is still higher in elderly patients. Picture 1 Funding Acknowledgement Type of funding source: None