The actuarial survival analysis of the surgical and non-surgical therapy regimen for chronic thromboembolic pulmonary hypertension

Gan, Hui-Li; Zhang, Jianqun; Bo, Ping; Zhou, Qiwen; Wang, Sheng-Xun

doi:10.1007/s11239-009-0319-1

Cited by 13 publications

(24 citation statements)

References 20 publications

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“…Only the most recent publications with the most complete data set from each institute were retained. As a result, 19 studies 6,15,21,22,25,26,29,30,33,35,36,38,40,[42][43][44][46][47][48] with a total number of 2729 patients were included for appraisal and data extraction ( Table 2).…”

Section: Quantity Of Evidencementioning

confidence: 99%

“…Four prospective studies were identified, 30,38,40,46) ; other studies were either clearly retrospective 6,15,22,25,29,35,42,44,47,48) or not specified. 21,26,33,43) Two studies presented results in a series of CTEPH patients treated surgically and medically 40,47) ; others included only series of surgically treated patients. There was one retrospective study from Austria that compared hemodynamic indices between PTE and non-PTE patients with a 1-year follow-up, but could not be included in the current review due to insufficient data to meet the inclusion criteria.…”

Section: Quality Of Evidencementioning

confidence: 99%

“…25,29,33,42) With the exception of one multicenter study from the UK 40) and another study from Germany including two centers, 36) other studies were from single tertiary referral centers. 6,15,21,22,25,26,29,30,33,35,38,[42][43][44][46][47][48] The largest series included 988 patients who underwent isolated PTE from 1997 to 2007 at UCSD. 6) Seven series had more than 100 patients, 6,15,25,38,40,44,47) five had between 50 and 100 patients (range 50-88), 22,29,30,35,43) and the other seven series had less than 50 patients each (range 23-41).…”

Section: Quality Of Evidencementioning

confidence: 99%

“…6,15,21,22,25,26,29,30,33,35,38,[42][43][44][46][47][48] The largest series included 988 patients who underwent isolated PTE from 1997 to 2007 at UCSD. 6) Seven series had more than 100 patients, 6,15,25,38,40,44,47) five had between 50 and 100 patients (range 50-88), 22,29,30,35,43) and the other seven series had less than 50 patients each (range 23-41). 21,26,33,36,42,46,48) The surgical technique was clearly described in one study, 6) and some modifications to Jamieson's technique were described in two studies.…”

Section: Quality Of Evidencementioning

confidence: 99%

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Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension : A Systematic Review

Rahnavardi

Yan

Cao

et al. 2011

ATCS

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Purpose: Pulmonary thromboendarterectomy (PTE) is a treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). The present systematic review was performed to assess the safety and efficacy of PTE for CTEPH. Methods: A systematic review was performed, and six electronic databases were searched for published studies from January 1999 to February 2010. All articles that presented morbidity and mortality data, survival data or preoperative and postoperative pulmonary hemodynamic indices were included. The primary outcome measures extracted were early morbidity and mortality, pulmonary hemodynamic and functional outcome indices prior to and after the operation, and survival data. Results: Of the 654 publications retrieved, 19 relevant papers (total number of 2729 patients) representing the most recent and complete data set from each institute, were included for appraisal and data extraction. No randomized controlled trials or matched comparative studies were identified. Thirty-day mortality ranged from 1.3% to 24% (median 8%). Residual pulmonary hypertension was reported in 11%-35% of patients after PTE. Pulmonary artery pressure and pulmonary vascular resistance significantly decreased after PTE in all studies. Before PTE, 60%-100% of patients were in NYHA functional class III or IV. This percentage decreased to 0%-21% after PTE. Five-year survival ranged from 74% to 89%. Conclusions: The current literature suggests that PTE for patients with CTEPH is associated with acceptable perioperative morbidity and mortality rates and improved hemodynamic indices and survival when viewed against the prognosis associated with historical controls using medical therapy.

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Section: Quantity Of Evidencementioning

confidence: 99%

Section: Quality Of Evidencementioning

confidence: 99%

Section: Quality Of Evidencementioning

confidence: 99%

Section: Quality Of Evidencementioning

confidence: 99%

See 2 more Smart Citations

Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension : A Systematic Review

Rahnavardi

Yan

Cao

et al. 2011

ATCS

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“…Other parts of the world, including India [13], China [14,15], and Russia [16], have reported improved outcomes after pulmonary endarterectomy, and surgical techniques and expertise are improving. On the other hand, in Japan for example, balloon pulmonary angioplasty (BPA) as a treatment for CTEPH is emerging [17] at least in part due to lack of surgical expertise in and/or availability of pulmonary endarterectomy, cultural reasons, and the available expertise in percutaneous interventional therapies.…”

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confidence: 99%

Chronic Thromboembolic Pulmonary Hypertension: A Worldwide View of How Far We Have Come

Fares

Heresi

2016

Lung

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Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group 4 based on the World Health Organization (WHO) classification [1]. The diagnosis of CTEPH is predicated upon the presence of pulmonary hypertension (PH), defined via right heart catheterization as a mean pulmonary artery pressure C25 mm Hg at rest, in association with persistent pulmonary perfusion defects, despite therapeutic anticoagulation [2]. In CTEPH patients, after an episode or more of pulmonary embolism (PE), there is incomplete resolution of emboli that obstruct or narrow elastic pulmonary arteries. In addition, a progressive distal small vessel vasculopathy develops overtime [3]. The combination of large vessel obstruction and microvascular disease accounts for the elevated pulmonary pressures, and dictate the treatment approach: surgical removal of fibrotic thrombi, the preferred approach versus medical therapy [4].The reported incidence of CTEPH after PE is variable, but it is unquestionable that CTEPH is an under-recognized disease. If one applies a conservative rate of 1-3 % after PE [4] to the estimated half a million PE survivors in the United States, one ends with around 5000-15,000 new CTEPH cases every year, a number that clearly is not being taken care of by CTEPH centers. This underscores the importance of a heightened awareness, especially for patients with persistent cardiopulmonary symptoms 3-6 months after an episode of acute PE, and for patients with known PH. The ventilation perfusion (VQ) scan remains the screening test of choice due to its high sensitivity [5] and straightforward interpretation. One or more segmental or larger perfusion defects should trigger further work for CTEPH, including pulmonary angiography via computed tomography (CT), and conventional digital subtraction angiography. While CT pulmonary angiography has become the test of choice for the diagnosis of acute PE, CT findings of chronic thromboembolism are frequently more difficult to be ascertained, and require considerable levels of experience and expertise.Once the CTEPH diagnosis is established, operability assessment by an experienced CTEPH center is recommended [6], as pulmonary endarterectomy (also called pulmonary thromboendarterectomy or PTE) [7] is the only treatment that offers the potential for cure. A majority of patients, approximately 2/3 in the international CTEPH registry [8], are deemed operable. The operation and postoperative care are highly complex and should be performed only in centers with experienced CTEPH teams. When the surgery is not indicated, as determined by an expert center, and for those with PH after surgery, targeted PH therapy is known to be effective [9,10].As noted, the diagnosis and treatment of CTEPH present significant challenges, which can certainly be magnified in health care environments with fewer resources. In this issue of Lung, Al-Naamani et al. report on the experience of a CTEPH cohort registry (REPHPISSSTE registry) in two medical centers in Mexico [11]. Out of the 45 patients who were ev...

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Chronic Thromboembolic Pulmonary Hypertension: Experience from a Single Center in Mexico

Al‐Naamani

Espitia

Velazquez-Moreno

et al. 2016

Lung

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Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by precapillary pulmonary hypertension secondary to vaso-occlusive pulmonary vasculopathy and is classified as Pulmonary Hypertension Group 4. The aim of this study is to report the clinical experience of CTEPH in Mexico. Methods Consecutive patients diagnosed with CTEPH were identified from the Registro de Pacientes con Hipertension Pulmonar del Instituto de Seguridad y Servicio Social de los Trabajadores del Estado (REPHPISSSTE) registry between January 2009 and February 2014. Right heart catheterization was not routinely performed prior to August 2010 in the work-up of CTEPH. Results We identified 50 patients with CTEPH; their median age was 63 years and 58 % were female. Patients had multiple associated co-morbidities and moderate hemodynamic impairment. All patients were treated with anticoagulation. Despite surgical evaluation for pulmonary endarterectomy (PEA), only one patient underwent PEA given the lack of infrastructure for post-operative care and lack of insurance for this procedure. Most of the patients were treated with sildenafil, bosentan, or both, with increasing use of rivaroxaban and sildenafil in recent years. The overall survival of the cohort was similar to that reported in other international registries, despite the limitations of care imposed by drug availability and surgical feasibility. Conclusion This is the first report on the CTEPH experience in Mexico. It highlights the similarity of patients in the REPHPISSSTE registry to those in international registries as well as the challenges that clinicians face in a resource-limited setting.

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The actuarial survival analysis of the surgical and non-surgical therapy regimen for chronic thromboembolic pulmonary hypertension

Abstract: The PTE procedure has statistically superiority over thrombolytic therapy for the proximal type of CTEPH in terms of actuarial survival; however, for the distal type of CTEPH, the PTE procedure provides no benefits with regard to actuarial survival.

Cited by 13 publications

References 20 publications

Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension : A Systematic Review

Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension : A Systematic Review

Chronic Thromboembolic Pulmonary Hypertension: A Worldwide View of How Far We Have Come

Chronic Thromboembolic Pulmonary Hypertension: Experience from a Single Center in Mexico

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