Abstract:

Background: The contemporary outcome of balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) are unclear.

Objectives: This study aimed to clarify the characteristics and outcomes of CTEPH patients treated with BPA and PEA in Japan.

Methods: Among 1,270 participants enrolled between 2018-2023 in the CTEPH AC registry, a Japanese nationwide CTEPH registry, 369 treatment-naïve patients (BPA strategy: n=313; PEA strategy: n=56) and 690 on-treatment patients (BPA strategy: n=561, PEA strategy: n=129) were classified according to the presence of prior reperfusion therapy. Morbidity and mortality events (all-cause death, rescue mechanical reperfusion therapy, and/or initiation of parenteral pulmonary vasodilators), pulmonary hemodynamics, exercise tolerance, and relevant laboratory test results were evaluated.

Results: The BPA strategy was chosen in older patients than the PEA strategy (mean [SD] age, BPA vs PEA: 66.5 [12.6] vs 62.5 [11.8] years; P=0.028). Median (Q1-Q3) follow-up period was 615 (311-997) days in treatment-naïve patients and 1136 (684-1300) days in on-treatment patients. BPA strategy had as acceptable morbidity and mortality as PEA strategy (5-year morbidity and mortality event rate, BPA vs PEA: 10.2% [95%CI 5.2%-19.5%] vs 16.1% [95%CI 4.3%-50.6%] in treatment-naïve patients, 9.7% [95%CI 6.7%-13.8%] vs 6.9% [95%CI 2.7%-17.3%] in on-treatment patients), with greater improvement of renal function; glomerular filtration rate in propensity score-matched population (difference between change, 4.9 [95%CI 0.5-9.3] mL·min^-1·1.73m^-2; P=0.030).

Conclusions: BPA strategy was more frequently chosen in older patients compared to PEA strategy and showed acceptable outcomes for efficacy with greater advantage for improvement in renal function. 

JACC: Asia Editor-in-Chief 

Jian’an Wang, MD, PhD, FACC

CME Editor 

Kenneth A. Ellenbogen, MD

Author
Nidhi Madan, MD, MPH

Important Dates

Date of Release: August 6, 2024
Term of Approval/Date of CME/MOC Expiration: August 5, 2025