The long-term outcome of chronic thromboembolic pulmonary hypertension: Pulmonary endarterectomy and balloon pulmonary angioplasty

Author:

Yang Kuo-Ming1,Wang Mei-Tzu123,Tao Chi-Wei4,Wu Yih-Jer5,Hsu Chih-Hsin67,Liao Wei-Chih8,Hsu Hsao-Hsun9,Lin Meng-Chih10,Tsai Fu-Ting11,Fu Yun-Ju11,Kuo Feng-Yu1,Cheng Chin-Chang1212,Hung Cheng-Chung12,Wang Hao-Chien1314,Yu Chong-Jen15,Huang Wei-Chun1231216

Affiliation:

1. Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC

2. Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC

3. School of Medicine, National Yang Ming Chaio Tung University, Taipei, Taiwan, ROC

4. Division of Pulmonary Medicine, Department of Internal Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC

5. Department of Medicine, MacKay Medical College and Cardiovascular Center, MacKay Memorial Hospital, New Taipei, Taiwan, ROC

6. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC

7. Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan, ROC

8. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, ROC

9. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC

10. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC

11. Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

12. Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC

13. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC

14. Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan, ROC

15. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC

16. Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC

Abstract

Background: The long-term outcome on patients with chronic thromboembolic pulmonary hypertension (CTEPH) has not been ideal after standard medical treatment. However, good outcome for patients with CTEPH after interventions such as pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) has been reported recently. The aim of this study was to evaluate the impact of PEA or BPA on long-term outcomes for CTEPH patients in Han-Chinese population. Methods: This was a multi-center, prospective case-control study. Patients with CTEPH were enrolled between January, 2018 and March, 2020. They were divided into two groups, including intervention (PEA or BPA) and conservative groups. The followed-up period was 26 months after treatment. The endpoints were all-cause mortality and CTEPH mortality. Results: A total of 129 patients was enrolled and assigned to receive PEA/BPA (N=73), or conservative therapy (N=56). Overall, the 26-month survival rate of all-cause mortality was significantly higher in intervention group compared to that in conservative group (95.89%. vs. 80.36%; log-rank p = 0.0164). The similar trend was observed in the 26-month survival rate of CTEPH mortality (97.26% vs. 85.71%; log-rank p = 0.0355). Regarding cox proportional-hazard regression analysis, the hazard ratios (HR) on patients with CTEPH receiving intervention in the outcome of all-cause mortality and CTEPH mortality were statistically significant [HR = 0.07 and p = 0.0141 in all-cause mortality; HR = 0.11 and p = 0.0461 in CTEPH mortality]. Conclusion: This multi-center prospective case-control study demonstrated that intervention such as PEA and BPA increased the long-term survival rate for patient with CTEPH significantly. Intervention was an independent factor in long-term outcome for patients with CTEPH, including all-cause mortality and CTEPH mortality.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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