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The role of balloon pulmonary angioplasty and pulmonary endarterectomy: Is chronic thromboembolic pulmonary hypertension still a life-threatening disease?

Authors
  • Taniguchi, Yu1
  • Matsuoka, Yoichiro2
  • Onishi, Hiroyuki2
  • Yanaka, Kenichi2
  • Emoto, Noriaki2
  • Nakai, Hidekazu3
  • Okada, Kenji3
  • Hirata, Kenichi2
  • 1 Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan. Electronic address: [email protected] , (Japan)
  • 2 Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan. , (Japan)
  • 3 Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Japan. , (Japan)
Type
Published Article
Journal
International journal of cardiology
Publication Date
Oct 18, 2020
Identifiers
DOI: 10.1016/j.ijcard.2020.10.026
PMID: 33086125
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The management of non-operable chronic thromboembolic pulmonary hypertension (CTEPH) has evolved with the availability of balloon pulmonary angioplasty (BPA) and pulmonary vasodilators. We launched the BPA program in 2011. The aim was to analyze the survival and treatment efficacy of our CTEPH treatment program in the modern management era. We retrospectively reviewed data from 143 consecutive CTEPH patients diagnosed from January 2011 (i.e. after the availability of BPA) to December 2019. Of forty-one patients who underwent pulmonary endarterectomy (PEA), 25 underwent additional BPA (Combination group) and the others were treated with only PEA (PEA group). Ninety patients underwent BPA (BPA group). The remaining 12 patients did not undergo any interventional treatments. The 1- and 5-year survival rates of operated patients (n = 41) were 97.4% and 90.0%, compared to 96.9% and 86.9% in not-operated patients (n = 102), respectively (p = 0.579). There was no mortality in the Combination group. Mean pulmonary artery pressure after treatments in the PEA only, Combination, and BPA only groups was 20.5 ± 6.7, 17.9 ± 4.9, and 20.7 ± 4.6 mmHg, respectively (p = 0.067, one-way ANOVA). Percent decrease of pulmonary vascular resistance in each treatment groups was -73.7 ± 11.3%, -74.3 ± 11.8%, and - 54.9 ± 22.5%, respectively (p < 0.01, one-way ANOVA). There was no significant difference in long-term survival between operated and not-operated CTEPH. Moreover, the Combination approach might have the potential to introduce notable improvements in the prognosis of CTEPH. BPA and PEA appear to be mutually complementary therapies in the modern management era. Copyright © 2020. Published by Elsevier B.V.

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