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A new era of therapeutic strategies for chronic thromboembolic pulmonary hypertension by two different interventional therapies; pulmonary endarterectomy and percutaneous transluminal pulmonary angioplasty Inami T; Kataoka M; Ando M; Fukuda K; Yoshino H; Satoh TPLoS One 2014[]; 9 (4): e94587BACKGROUND: Pulmonary endarterectomy (PEA) is established for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Recently, percutaneous transluminal pulmonary angioplasty (PTPA) has been added for peripheral-type CTEPH, whose lesions exist in segmental, subsegmental, and more distal pulmonary arteries. A shift in clinical practice of interventional therapies occurred in 2009 (first mainly PEA, later PTPA). We examined the latest clinical outcomes of patients with CTEPH. METHODS AND RESULTS: This study retrospectively included 136 patients with CTEPH. Twenty-nine were treated only with drug (Drug-group), and the other 107 underwent interventional therapies (Interventions-group) (39 underwent PEA [PEA-group] and 68 underwent PTPA [PTPA-group]). Total 213 PTPA sessions (failures, 0%; mortality rate, 1.47%) was performed in the PTPA-group (complications: reperfusion pulmonary edema, 7.0%; hemosputum or hemoptysis, 5.6%; vessel dissection, 2.3%; wiring perforation, 0.9%). Although baseline hemodynamic parameters were significantly more severe in the Interventions-group, the outcome after the diagnosis was much better in the Interventions-group than in the Drug-group (98% vs. 64% 5-year survival, p<0.0001). Hemodynamic improvement in the PEA-group was a 46% decrease in mean pulmonary arterial pressure (PAP) and a 49% decrease in total pulmonary resistance (TPR) (follow-up period; 74.7 +/- 32.3 months), while those in the PTPA-group were a 40% decrease in mean PAP and a 49% decrease in TPR (follow-up period; 17.4 +/- 9.3 months). The 2-year survival rate in the Drug-group was 82.0%, and the 2-year survival rate, occurrence of right heart failure, and re-vascularization rate in the PEA-group were 97.4%, 2.6%, and 2.8%, and those in the PTPA-group were 98.5%, 2.9%, and 2.9%, respectively. CONCLUSION: The patients who underwent interventional therapies had better results than those treated only with drugs. The availability of both of these operative and catheter-based interventional therapies leads us to expect the dawn of a new era of therapeutic strategies for CTEPH.|*Angioplasty/adverse effects/mortality[MESH]|*Endarterectomy/adverse effects/mortality[MESH]|Chronic Disease[MESH]|Endpoint Determination[MESH]|Exercise[MESH]|Female[MESH]|Hemodynamics[MESH]|Humans[MESH]|Hypertension, Pulmonary/*complications/mortality/physiopathology/*surgery[MESH]|Kaplan-Meier Estimate[MESH]|Male[MESH]|Middle Aged[MESH]|Natriuretic Peptide, Brain[MESH]|Postoperative Complications/etiology/physiopathology[MESH]|Practice Patterns, Physicians'[MESH]|Pulmonary Embolism/*complications/mortality/physiopathology/*surgery[MESH]|Treatment Outcome[MESH] |
