Pulmonary endarterectomy and the cost of patient refusal

We would like to thank N.H. Kim and E. Mayer for their editorial based on our recent paper "The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension" [1, 2]. We agree with many of their comments pertaining to the importance of referring patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) for assessment by a pulmonary endarterectomy (PEA) programme. We would, however, like to correct certain factual errors in their editorial which we feel create an incorrect picture of our practice at a large tertiary pulmonary hypertension referral centre. First, N.H. Kim and E. Mayer state that following remote assessment by a surgeon at our national PEA centre, 278 (50%) out of 550 of patients were deemed not to be candidates for PEA surgery. In fact, figure 1 in our original article [1] shows that 81% (448 out of 550) of patients were deemed by our national CTEPH multidisciplinary team (MDT) to have potentially surgical disease, while 19% (102 out of 550) were felt to have inoperable disease due to disease distribution. This figure was very similar to the 21% (140 out of 679) of the international CTEPH registry patients who were not offered surgery because of disease distribution when compared to pulmonary haemodynamic derangement [3]. Overall, the proportion of patients in our study who did not undergo PEA for reasons other than disease distribution and patient choice was not dissimilar to that observed in the international CTEPH registry (17% versus 12%).

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Pulmonary endarterectomy and the cost of patient refusal

Abstract: The recommended treatment for operable chronic thromboembolic pulmonary hypertension is pulmonary endarterectomy, and patients who refused surgery in the current study had worse longterm survival than those who underwent surgery http://ow.ly/WJ0P30lBxY9

Cited by 2 publications

References 20 publications

FOCUS on sequelae of acute pulmonary embolism: does it pay off?

FOCUS on sequelae of acute pulmonary embolism: does it pay off?

Decision-making in pulmonary endarterectomy surgery

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