EXPRESS: Time Trends of Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is considered as a rare but severe complication after acute pulmonary embolism (PE) and is potentially curable by pulmonary endarterectomy (PEA). We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of PEA in CTEPH patients and to investigate predictors of the in-hospital course. We analyzed data on the characteristics, comorbidities, treatments and in-hospital outcomes for all CTEPH patients treated with PEA in the German nationwide inpatient sample between 2006 and 2016. Overall, 1,398 inpatients were included. Annual number of PEA increased from 67 in 2006 to 194 in 2016 (P<0.001), in parallel with a significant decrease of in-hospital mortality (10.9% in 2008 to 1.5% in 2016; P<0.001). Patientsâ characteristics shifted slightly towards older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Independent predictors of in-hospital mortality were age (OR 1.03 [95%CI 1.01-1.05]; P=0.001), right heart failure (2.55 [1.37-4.76]; P=0.003), in-hospital complications such as ischemic stroke (6.87 [1.06-44.70]; P=0.044) and bleeding events like hemopneumothorax (24.93 [6.18-100.57]; P<0.001). Annual PEA volumes per center below 10 annual procedures were associated with higher rates of adverse in-hospital outcomes. Annual numbers of CTEPH patients treated with PEA increased markedly in Germany between 2006 and 2016, in parallel with a decrease of in-hospital mortality. Our findings suggest that perioperative management of PEA, institutional experience and patient-selection are crucial and have improved over time.

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Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension

European Heart Journal ◽

10.1093/ehjci/ehaa946.2265 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Hobohm ◽

K Keller ◽

T Munzel ◽

S.V Konstantinides ◽

M Lankeit

Keyword(s):

Pulmonary Hypertension ◽

Hospital Mortality ◽

Time Trends ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Annual Number ◽

Funding Source ◽

Pulmonary Endarterectomy ◽

Hospital Outcomes ◽

Thromboembolic Pulmonary Hypertension ◽

Over Time

Abstract Background and purpose Chronic thromboembolic pulmonary hypertension (CTEPH) is considered as a rare but severe complication after acute pulmonary embolism (PE) and is potentially curable by pulmonary endarterectomy (PEA). We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of PEA in CTEPH patients in the German nationwide inpatient sample. Methods and results We analyzed data on the characteristics, comorbidities, treatments and in-hospital outcomes for all CTEPH patients treated with PEA in Germany between 2006 and 2016. Overall, 1,398 inpatients were included. The annual number of PEA increased from 67 in 2006 to 194 in 2016 (β 0.69 [95% CI 0.51 to 0.86]; p<0.001) in parallel with a significant decrease of in-hospital mortality (10.9% in 2008 to 1.5% in 2016; β −1.85 [95% CI: −2.46 to −1.24]; p<0.001). Patients' characteristics shifted slightly towards older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Independent predictors of in-hospital mortality were age and right heart failure, and in-hospital complications such as ischemic stroke and bleeding events. Conclusions The number of CTEPH patients treated with PEA increased markedly in Germany between 2006 and 2016, in parallel with a decrease of in-hospital mortality. Our findings may suggest that the perioperative management of PEA and the general patients' selection have improved over time and might draw more attention to predictors for in-hospital mortality for CTEPH patients hospitalized for PEA. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).

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The anticoagulant effects of warfarin and the bleeding risk associated with its use in patients with chronic thromboembolic pulmonary hypertension at a specialist center in Japan: a retrospective cohort study

Pulmonary Circulation ◽

10.1177/2045893217717258 ◽

2017 ◽

Vol 7 (3) ◽

pp. 684-691 ◽

Cited By ~ 4

Author(s):

Takayuki Jujo-Sanada ◽

Nobuhiro Tanabe ◽

Seiichiro Sakao ◽

Toshihiko Sugiura ◽

Ayumi Sekine ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Bleeding Risk ◽

Incidence Rates ◽

Pulmonary Endarterectomy ◽

Bleeding Events ◽

Thromboembolic Pulmonary Hypertension ◽

Recurrent Vte ◽

Clinical Records ◽

Observation Period

Patients with chronic thromboembolic pulmonary hypertension (CTEPH) require lifelong anticoagulation therapy. However, the bleeding risk and recurrence of venous thromboembolism (VTE) in CTEPH patients who are administered warfarin have not been adequately evaluated. The purpose of this study was to evaluate the risk of clinically relevant bleeding, recurrent VTE, and clinical worsening in patients with CTEPH who were administered warfarin. The clinical records of 72 patients with CTEPH who regularly visited our institution and were administered warfarin were retrospectively reviewed between 1 January 2011 and 31 December 2015. We investigated the incidence of clinically relevant bleeding events, recurrent VTE, and hospitalization for the deterioration of pulmonary hypertension or right heart failure (RHF) during the observation period. The mean observation period for the 72 patients was 3.60 ± 1.60 person-years. Clinically relevant bleeding, RHF, and recurrent VTE occurred in 21 (29.2%), eight (11.1%), and three (4.2%) of 72 patients, respectively, and the incidence rates for these events were 8.1%/person-year, 3.1%/person-year, and 1.2%/person-year, respectively. The incidence rates for the major and non-major bleeding events were 5.0%/person-year and 3.9%/person-year, respectively. The incidence of clinically relevant bleeding events was 20.8%/person-year during medical treatment with a soluble guanylate cyclase stimulator. One of 35 patients (2.9%) during the post-pulmonary endarterectomy period experienced hemoptysis during observation period (> 6 months after pulmonary endarterectomy). No bleeding events occurred during the post-balloon pulmonary angioplasty period. In conclusion, warfarin effectively prevents VTE recurrence in CTEPH patients, but its effects may be associated with a considerable bleeding risk.

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Sex Differences in Chronic Thromboembolic Pulmonary Hypertension. Treatment Options over Time in a National Referral Center

Journal of Clinical Medicine ◽

10.3390/jcm10184251 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4251

Author(s):

Alejandro Cruz-Utrilla ◽

María José Cristo-Ropero ◽

Miguel Calderón-Flores ◽

Maite Velázquez ◽

María Jesús López-Gude ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Sex Differences ◽

Treatment Options ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Functional Class ◽

Pulmonary Endarterectomy ◽

Pulmonary Vasodilators ◽

Thromboembolic Pulmonary Hypertension ◽

New Treatments ◽

Over Time

(1) Background: Clinical presentation, disease distribution, or treatment received may provide insights into the reasons contributing to sex differences in chronic thromboembolic pulmonary hypertension (CTEPH). (2) Methods: We evaluated 453 patients (56% women) between 2007–2019. Data was collected from REHAP (Registro Español de Hipertensión Arterial Pulmonar) registry. Two time periods were selected to evaluate the influence of new treatments over time. (3) Results: Women were older. Baseline functional class was worse, and distance walked shorter in women compared with men. Women had higher pulmonary vascular resistances. Despite this, pulmonary endarterectomy (PEA) was carried out in more men, and women received more frequently pulmonary vasodilators exclusively. The 2014–2019 interval was associated with a better survival only among women. Interestingly, women had a more distal disease during this second period of time. (4) Conclusions: Even though women were older, and received invasive treatments less frequently, mortality was similar in both sexes. The introduction of balloon pulmonary angioplasty and the improvement of pulmonary endarterectomy, especially during the last years, could be associated with a survival benefit among women.

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Faculty Opinions recommendation of Bosentan as a bridge to pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1355970.827071 ◽

2010 ◽

Author(s):

John Augoustides ◽

Harish Ramakrishna

Keyword(s):

Pulmonary Hypertension ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Pulmonary Endarterectomy ◽

Thromboembolic Pulmonary Hypertension

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Pulmonary Endarterectomy: Assessment of Operability, Surgical Description, and Post-op Care

Advances in Pulmonary Hypertension ◽

10.21693/1933-088x-12.4.186 ◽

2014 ◽

Vol 12 (4) ◽

pp. 186-192 ◽

Cited By ~ 1

Author(s):

David Poch ◽

Victor Pretorius

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Pulmonary Arteries ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Pulmonary Artery Wedge Pressure ◽

Pulmonary Endarterectomy ◽

Pulmonary Thromboendarterectomy ◽

Thromboembolic Pulmonary Hypertension ◽

Wedge Pressure

Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a mean pulmonary artery pressure ≥25 mm Hg and pulmonary artery wedge pressure ≤15 mm Hg in the presence of occlusive thrombi within the pulmonary arteries. Surgical pulmonary thromboendarterectomy (PTE) is considered the best treatment option for CTEPH.

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EXPRESS: Chronic thromboembolic pulmonary hypertension following pulmonary embolism with a right ventricular thrombus: A report of two cases

Pulmonary Circulation ◽

10.1177/20458940211013668 ◽

2021 ◽

pp. 204589402110136

Author(s):

Tailong Zhang ◽

Weitao Liang ◽

Longrong Bian ◽

Zhong Wu

Keyword(s):

Pulmonary Hypertension ◽

Right Ventricular ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Imaging Features ◽

Pulmonary Endarterectomy ◽

Right Heart ◽

Thromboembolic Pulmonary Hypertension ◽

The Right ◽

Cardiac Masses

Right heart thrombus (RHT) accompanied by chronic thromboembolic pulmonary hypertension (CTEPH) is a rare entity. RHT may develop in the peripheral veins or in situ within the right heart chambers. The diagnosis of RHT is challenging, since its symptoms are typically non-specific and its imaging features resemble those of cardiac masses. Here, we report two cases of RHT with CTEPH that presented as right ventricular masses initially. Both patients underwent simultaneous pulmonary endarterectomy (PEA) and resection of the ventricular thrombi. Thus, when mass-like features are confirmed by imaging, RHT should be suspected in patients with CTEPH, and simultaneous RHT resection is required along with PEA.

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Atrial fibrillation and atrial tachycardia in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa096 ◽

2020 ◽

Vol 22 (Supplement_F) ◽

pp. F30-F37

Author(s):

Stepan Havranek ◽

Zdenka Fingrova ◽

David Ambroz ◽

Pavel Jansa ◽

Jan Kuchar ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Hypertension ◽

Atrial Tachycardia ◽

Cox Regression ◽

Systolic Pressure ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Walking Distance ◽

Pulmonary Artery Systolic Pressure ◽

Pulmonary Endarterectomy ◽

Thromboembolic Pulmonary Hypertension

Abstract Atrial fibrillation (AF) and atrial tachycardia (AT) are frequently observed in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who were treated with pulmonary endarterectomy (PEA). Their prevalence and impact on prognosis of patients are not known. We analysed the prevalence of AF/AT and the clinical outcome in 197 patients with CTEPH treated with PEA (median age 62; interquartile range 53–68 years; 62% males). The prevalence of AF/AT was 29% (57 patients). Compared to patients without arrhythmia, the subjects with AF/AT were older [60 (50–67) vs. 62 (57–70) years], manifested an increased size of the left atrium [39 (35–44) vs. 45 (40–50) mm], had a reduced 6-min walking distance [411 (321–506) vs. 340 (254–460) m], and higher pulmonary artery systolic pressure after PEA [38 (30–47) vs. 45 (38–71) mmHg], all results with P-value <0.05. During the follow-up with a median 4.2 (1.6–6.3) years, 45 (23%) patients died. In a multivariate Cox regression model only the male gender [hazard ratio (HR) 2.27, 95% confidence interval (CI) 1.15–4.50], a reduced 6-min walking distance (HR 3.67, 95% CI 1.74–7.73), and an increased New York Heart Association class (HR 8.56, 95% CI 4.17–17.60) were associated with mortality (P < 0.05). The prevalence of AF/AT in patients with CTEPH treated with PEA is high. Arrhythmias are associated with reduced functional capacity but not with mortality.

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