82% of patients with chronic thromboembolic pulmonary hypertension undergo pulmonary endarterectomy with excellent long-term survival.

Out of three different current therapy choices, 82% of patients with chronic thromboembolic pulmonary hypertension (CTEPH) are surgically treated with pulmonary endarterectomy (PEA). An analysis revealed excellent long-term treatment survival in patients who undergo surgery, with no difference to balloon pulmonary angioplasty (BPA).

In the United Kingdom, the treatment decision in patients with CTEPH is made by a multidisciplinary team that considers factors like anatomical clot distribution, operability, and patient’s choice. The presented analysis included over 1,300 patients treated between 2015 and 2022, of whom 82% received PEA. The other two possible modalities of therapy consisted of either BPA or noninterventional (NI) medical treatment.

At baseline, the three groups varied significantly in median age (P<0.001): 60 years in PEA, 67 years in BPA, and 74 years in NI. Other significant differences between the groups included the median values for the 6-minute walk test and NT-proBNP. The groups also differed in baseline median mean pulmonary artery pressure (mPAP): PEA, 46 mm Hg; BPA, 41 mm Hg, and NI, 44 mm Hg. At follow-up, the median difference in mPAP in the PEA, BPA, and NI arm were −17 mm Hg, −8 mm Hg, and −1 mm Hg, respectively. Median difference in pulmonary vascular resistance in dynes/s/cm^-5 reached −353 (PEA), −175 (BPA), and −147 (NI). A Kaplan-Meier-analysis revealed a 3-year survival of 91% in the PEA group, 96% in the BPA, and 64% in the NI arm. When early deaths after surgery were excluded, the comparison between 3-year survival after PEA and BPA did not yield a statistical difference.

At the 2023 ERS International Congress, Paula Appenzeller stated that the study showed excellent long-term survival in CTEPH patients treated by an intervention, with no significant difference between PEA and BPA at 3 years. “To offer multimodality treatment and to optimize outcome for an individual patient, an experienced multidisciplinary team is needed to provide treatment selection as the treatments may be used alongside but they are not interchangeable as they target different disease distributions,” Appenzeller concluded.

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