Pulmonary Endarterectomy (PEA) vs. Balloon Pulmonary Angioplasty (BPA) in Chronic Thrombo-Embolic Pulmonary Hypertension (CTEPH): Comparison of Improvements in Hemodynamics and Functional Capacity

Abstract

<h3>Purpose</h3> While the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) is an emerging option for inoperable patients. Data comparing improvements in hemodynamics and functional capacity of these treatment modalities are scarce. <h3>Methods</h3> In a single center prospective patient cohort, we compared hemodynamics by right heart catheterization and exercise by cardiopulmonary exercise testing (CPET) at admission and 5 months (±14 days) following treatment. Comprehensive evaluation and selection for PEA or BPA was performed by an expert CTEPH team. <h3>Results</h3> With similar patient characteristics and a mean age of 60 years, the two groups consisted of 96 consecutive patients who were treated with PEA (n=42) or BPA (n=54). A mean number of 4.6 [2-11] BPA procedures per patient were performed in the BPA group. Eight patients who were initially treated with PEA later received BPA due to residual pulmonary hypertension. At baseline, no significant between-group differences were observed regarding hemodynamics or exercise capacity. At follow up, PEA reduced mPAP and PVR to significantly lower levels than BPA. However, there were no significant between-group differences regarding improvements in cardiac output, central venous oxygen saturation, or exercise capacity. <h3>Conclusion</h3> In our experience, PEA improves pulmonary arterial pressure and pulmonary arterial vascular resistance to significantly lower levels than with BPA. Nevertheless, with similar improvements in cardiac output and mixed venous oxygen saturation, exercise capacity increased to the same extent in both Groups.