Outcomes of Patients with Chronic Thromboembolic Pulmonary Hypertension Risk Stratified by a Dedicated Heart Team to Receive Pulmonary Endarectomy or Balloon Pulmonary Angiogiplasty

Purpose Chronic thromboembolic pulmonary hypertension (CTEPH) is progressive condition characterised by fibro-thrombotic obstruction of pulmonary arteries, and is associated with significant mortality. Given techniques are evolving, there is still considerable variation in the literature regarding surgical and interventional outcomes. This study aims to determine outcomes for CTEPH patients undergoing pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty (BPA) in specialist pulmonary hypertension unit with treatment modality determined by a multi-disciplinary heart team. Methods This is a retrospective cohort study of all patients undergoing PEA or BPA between 2002 and June 2018. A team of experienced cardiologists, surgeons and interventional radiologists made decisions regarding treatment modality. Both haemodynamic, clinical and procedural outcomes were measured, and comparison was made between treatment groups. Only patients who had available pre- and post intervention right heart catheter data were included in the haemodynamic analysis. Results A total of 92 patients were included between the PEA group (n=65, age 58 ± 16, m=32, f= 33) and BPA group (n=27, age 65 ± 17, m=15, F=12). For haemodynamic outcomes, a total 52 patients (42 PEA, 10 BPA) were included. There were statistically significant improvements in pulmonary vascular resistance (PVR), mean pulmonary artery pressure (mPAP), mean right atrial pressure and cardiac index. Though the reductions in mPAP (PEA 21 mmHg vs. BPA12.5 mmHg) and PVR (PEA 527 ± 350 dyn.s.cm−5 vs. BPA 304 dyn.s.cm−5) were more marked in the PEA group, there was no statistically significant difference between the groups. There were two deaths (3%) post PEA and one death (3.7%) encountered post-BPA. Conclusion We conclude, that with careful patient selection and experienced proceduralists, there is significant improvement in haemodynamic outcomes with both surgery and intervention, and an acceptable complication profile.