Changes in the management of chronic thromboembolic pulmonary hypertension over a 10-year period, in a French expert regional competence centre - 15/09/23
Highlights |
• | Surgery remains the best treatment option for chronic thromboembolic pulmonary hypertension. |
• | Thromboendarterectomy is performed in less than a third of patients diagnosed in a regional centre. |
• | Balloon pulmonary angioplasty (BPA) should be proposed for inoperable cases. |
• | The survival after BPA is similar to that of operated patients. |
• | The survival of patients who underwent BPA is higher compared to those who received medical treatment only. |
Abstract |
Over the last few years, the advent of balloon pulmonary angioplasty (BPA) had led to changes in the management of chronic thromboembolic pulmonary hypertension (CTEPH). We reviewed data from 98 CTEPH patients diagnosed during the last decade in a pulmonary hypertension (PH) expert centre. The management modalities of 2 periods (Period A: 2011–15 and Period B: 2016–20) were compared. Age (period A: 72 [58–80] years; period B: 69 [62–79] years), clinical (New York Heart Association (NYHA) functional class III-IV: 25/41, 61% vs 39/57, 68%), and hemodynamic assessments (pulmonary vascular resistance: 7.5 [6.2–8.7] WU vs 8.0 [6.0–10.2] WU) at baseline were not significantly different. Pulmonary endarterectomy was performed in less than one third of patients (12, 29.3% vs 15, 26.3%). For patients not eligible for surgery, medical therapy was mostly prescribed alone during period A (medical therapy alone, patients diagnosed in period A: 61% vs in period B: 17.5%) while it was associated with BPA during period B (medical therapy + BPA, 12% vs 61.4%). The 5-year survival rate was excellent for patients who underwent surgery (96.3%) or BPA (95.2%), but was only 42.1% for patients under oral medication only (p < 0.0001). Patients diagnosed with CTEPH who cannot be operated should undergo BPA. The survival rate after BPA is as good as after surgery and significantly better than that of oral medication only.
El texto completo de este artículo está disponible en PDF.Keywords : Pulmonary hypertension, Thrombosis, Pulmonary endarterectomy, Angioplasty, Survival
Esquema
Changes in the management of CTEPH |
Vol 84
Artículo 101021- novembre 2023 Regresar al númeroBienvenido a EM-consulte, la referencia de los profesionales de la salud.
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