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Treatment of chronic thromboembolic pulmonary hypertension in a multidisciplinary team

Anna Siennicka1, Szymon Darocha2, Marta Banaszkiewicz3

  • 11st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.

Therapeutic Advances in Respiratory Disease
|December 28, 2019
PubMed

Insights

A multidisciplinary CTEPH team guides treatment decisions. Balloon pulmonary angioplasty (BPA) showed better survival than pulmonary endarterectomy (PEA) or medical therapy (MT) alone in chronic thromboembolic pulmonary hypertension (CTEPH) patients.

Area of Science:

  • Cardiology
  • Pulmonology
  • Vascular Surgery

Background:

  • Chronic thromboembolic pulmonary hypertension (CTEPH) management involves pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), and medical therapy (MT).
  • Multidisciplinary expert team assessment (CTEPH team) is crucial for treatment decision-making in CTEPH.

Purpose of the Study:

  • To evaluate the impact of an interdisciplinary CTEPH team approach on patient outcomes.
  • To compare the effectiveness of different treatment strategies (PEA, BPA, MT) within this multidisciplinary framework.

Main Methods:

  • Analysis of 160 patients evaluated by a CTEPH team between December 2015 and September 2018.
  • Assessment of baseline characteristics, team decisions, procedure implementation, World Health Organization (WHO) functional class changes, and survival rates by treatment strategy.
  • Stratification of patients into operable (underwent PEA) and inoperable groups.

Main Results:

  • Of 160 patients, 51 (32%) were deemed operable, with 31 (61% of operable) undergoing PEA.
  • PEA patients showed the greatest WHO functional class improvement.
  • Patients treated with BPA (+MT) had significantly better 2-year survival (92%) compared to PEA (79%) and MT alone (79%), despite being older.

Conclusions:

  • The CTEPH team effectively guides diagnostic and therapeutic pathways.
  • While PEA offers the best functional improvement in survivors, BPA demonstrates superior survival rates.
  • The interdisciplinary approach optimizes CTEPH patient management, with BPA emerging as a favorable option for specific patient groups.
Abstract

Keywords:
balloon pulmonary angioplastychronic thromboembolic pulmonary hypertensionmultidisciplinary teampulmonary endarterectomysurvival

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