The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension

Abstract

Pulmonary endarterectomy (PEA) is the gold standard treatment for operable chronic thromboembolic pulmonary hypertension (CTEPH). However, a proportion of patients with operable disease decline surgery. There are currently no published data on this patient group. The aim of this study was to identify outcomes and prognostic factors in a large cohort of consecutive patients with CTEPH.Data were collected for consecutive, treatment-naive CTEPH patients at the Pulmonary Vascular Disease Unit of the Royal Hallamshire Hospital (Sheffield, UK) between 2001 and 2014.Of 550 CTEPH patients (mean±sd age 63±15 years, follow-up 4±3 years), 49% underwent surgery, 32% had technically operable disease and did not undergo surgery (including patient choice n=72 and unfit for surgery n=63), and 19% had inoperable disease due to disease distribution. The 5-year survival was superior in patients undergoing PEA (83%) technically operable disease who did not undergo surgery (53%) and inoperable due to disease distribution (59%) (p<0.001). Survival was superior in patients following PEA compared with those offered but declining surgery (55%) (p<0.001). In patients offered PEA, independent prognostic factors included mixed venous oxygen saturation, gas transfer and patient decision to proceed to surgery.Outcomes in CTEPH following PEA are excellent and superior to patients declining surgery, and strongly favour consideration of a surgical intervention in eligible patients.

Expertentreffen COPD: Lunge und Herz – ziemlich oft gemeinsam krank!

“…In einer französischen Untersuchung wurden Patienten mit CTEPH je nach Operabilität des Befundes in verschiedene Gruppen eingeteilt und 12 Jahre nachbeobachtet [120]. Die mit Abstand beste Überlebenszeit hatten die operativ behandelten Patienten, und zwar unabhängig von ihrem Lebensalter.…”

Pulmonary endarterectomy and the cost of patient refusal

“…Another important limitation not discussed in the report by QUADERY et al [8] is that of determining surgical candidacy. Although each case underwent a multidisciplinary evaluation process, the assessment by the prospective operating surgeon was done remotely.…”

“…In the study by QUADERY et al [8], the prospective registry from Sheffield (UK) reported on 550 consecutive CTEPH patients enrolled from 2001 to 2014. A multidisciplinary team reviewed each case, with suitability for PEA being assessed remotely by an experienced surgeon at the national reference PEA centre, Papworth Hospital (Cambridge, UK).…”

“…QUADERY et al [8] acknowledged an important limitation of the report: the case series pre-dated riociguat therapy and balloon pulmonary angioplasty (BPA). Although these now established treatment modalities may have had an impact for the subgroup deemed inoperable, the cases refusing surgery were felt to be operable [12][13][14].…”

miRNA-PDGFRB/HIF1A-lncRNA CTEPHA1 Network Plays Important Roles in the Mechanism of Chronic Thromboembolic Pulmonary Hypertension

“…For the diagnosis of CTEPH, pulmonary endarterectomy is the first choice for treating CTEPH. 5) The lack of treatment will greatly increase the mortality rate 6) in the long run. Some researchers found that inflammation and abnormal pulmonary endothelial cells play a key role in CTEPH, 7,8) but the concrete mechanism associated with the gene and pathway of CTEPH is not yet clear.…”