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Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet
Published on: November 4, 2015
Outcomes of Multidisciplinary Care at a Chronic Thromboembolic Pulmonary Hypertension Center
S Christopher Malaisrie1, Stephen Chiu1, Daniel Schimmel2
1Division of Cardiac Surgery, Department of Surgery Northwestern University Feinberg School of Medicine Chicago Illinois.
Insights
A multidisciplinary team approach to chronic thromboembolic pulmonary hypertension (CTEPH) care shows excellent survival rates. Pulmonary thromboendarterectomy (PTE) and balloon pulmonary angioplasty (BPA) offer superior outcomes compared to medical management for CTEPH patients.
Area of Science:
- Cardiology
- Pulmonology
- Thoracic Surgery
Background:
- International guidelines advocate for multidisciplinary evaluation and care in chronic thromboembolic pulmonary hypertension (CTEPH).
- Limited data currently supports the efficacy of these multidisciplinary approaches for CTEPH management.
- This study addresses the need for evidence on comprehensive CTEPH care models.
Purpose of the Study:
- To evaluate the outcomes of a multidisciplinary team approach in the comprehensive care of CTEPH patients.
- To compare the effectiveness of pulmonary thromboendarterectomy (PTE), balloon pulmonary angioplasty (BPA), and medical management within a multidisciplinary framework.
Main Methods:
- A single-center cohort study involving 166 adult CTEPH patients evaluated between 2016 and 2022.
- Patients underwent PTE, BPA, or medical management following consensus by a multidisciplinary team (pulmonary hypertension physicians, surgeons, interventional cardiologists, radiologists).
- Data collected included procedural outcomes, survival rates, hemodynamic response, dyspnea, and functional class.
Main Results:
- 86% of patients received interventional therapies (100 PTE, 42 BPA); 14% received medical management.
- 30-day mortality was 0% for both PTE and BPA. 1- and 3-year survival rates were high for PTE (99%, 96%) and BPA (100%, 93%), but lower for medical management (79%, 79%).
- PTE demonstrated the most significant improvements in pulmonary vascular resistance (PVR), Borg Dyspnea Scale, and NYHA functional class compared to BPA and medical management (p < 0.01 for all).
Conclusions:
- A multidisciplinary team approach to CTEPH care is associated with excellent short- and long-term survival.
- Interventional therapies, particularly PTE, yield superior hemodynamic and functional outcomes compared to medical management.
- This comprehensive care model effectively stratifies patients and optimizes treatment selection for CTEPH.
Abstract:
Recent international guidelines recommend a multidisciplinary evaluation and care model for patients with chronic thromboembolic pulmonary hypertension (CTEPH), but there is a paucity of supporting data. The aim of this study was to describe the outcomes of a multidisciplinary team approach to the comprehensive care of CTEPH patients. This single-center cohort study enrolled 166 consecutive adult patients undergoing CTEPH treatment evaluation from 2016 to 2022 at a tertiary care, academic regional referral and comprehensive CTEPH center with pulmonary thromboendarterectomy (PTE) and balloon pulmonary angioplasty (BPA) capabilities. Patients underwent PTE, BPA, or medical management after consensus evaluation by a multidisciplinary team including pulmonary hypertension physicians, surgeons, interventional cardiologists, and radiologists. 86% (142/166) of patients underwent interventional therapies; 100 (60%) underwent PTE and 42 (25%) BPA. Of the 24 (14%) medically treated patients, 13 patients were offered but deferred intervention; 11 patients had non-intervenable disease. 30-day mortality in both PTE and BPA was 0%. 1- and 3-year survival was 99% and 96% for PTE, 100% and 93% for BPA, 79% and 79% for medical management. Patients who underwent PTE had the best hemodynamic response (∆PVR: PTE -278.8 ± 366.9 dyne/sec/cm5; BPA -15.9 ± 171.8 dyne/sec/cm5; medical -60.2 ± 233.1 dyne/sec/cm5; p = 0.001), largest improvement in Borg Dyspnea Scale; [PTE -1.0 (-2.8 to 0.0), BPA + 0.5 (-0.8 to 5.0), medical +1.0 (0.75 to 3.0), p = 0.01], and most improvement in NYHA functional class [% improving at least 1 functional class: PTE 64% (47/73), BPA 18% (5/28), medical 21% (4/19), p = 0.0004].
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