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Comparative Study
. 2019 Jan-Dec:13:1753466619891529.
doi: 10.1177/1753466619891529.

Treatment of chronic thromboembolic pulmonary hypertension in a multidisciplinary team

Anna Siennicka  1 , Szymon Darocha  2 , Marta Banaszkiewicz  3 , Piotr Kędzierski  3 , Anna Dobosiewicz  3 , Piotr Błaszczak  4 , Małgorzata Peregud-Pogorzelska  5 , Jarosław Damian Kasprzak  6 , Michał Tomaszewski  7 , Ewa Mroczek  8 , Bożena Zięba  9 , Danuta Karasek  10 , Katarzyna Ptaszyńska-Kopczyńska  11 , Katarzyna Mizia-Stec  12 , Tatiana Mularek-Kubzdela  13 , Anna Doboszyńska  14 , Ewa Lewicka  15 , Marcin Ruchała  4 , Maciej Lewandowski  5 , Sylwia Łukasik  7 , Łukasz Chrzanowski  6 , Dariusz Zieliński  16 , Adam Torbicki  3 , Marcin Kurzyna  3
Affiliations
Comparative Study

Treatment of chronic thromboembolic pulmonary hypertension in a multidisciplinary team

Anna Siennicka et al. Ther Adv Respir Dis. 2019 Jan-Dec.

Abstract

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) may be treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapy (MT). Assessment in a multidisciplinary team of experts (CTEPH team) is currently recommended for treatment decision making. The aim of the present study was to report the effects of such an interdisciplinary concept.

Methods and results: A total of 160 patients were consulted by the CTEPH team between December 2015 and September 2018. Patient baseline characteristics, CTEPH team decisions and implementation rates of diagnostic and therapeutic procedures were analysed. Change in World Health Organization (WHO) functional class and survival rates were evaluated by treatment strategy. A total of 51 (32%) patients were assessed as operable and 109 (68%) were deemed inoperable. Thirty-one (61% of operable patients) underwent PEA. Patients treated with PEA, BPA(+MT) and MT alone were 50.9 ± 14.7, 62.9 ± 15.1 and 68.9 ± 12.7 years old, respectively. At the follow-up, PEA patients had the highest WHO functional class improvement. Patients treated with BPA(+MT) had significantly better survival than PEA (p = 0.04) and MT patients (p = 0.04; 2-year survival of 92%, 79% and 79%, respectively).

Conclusions: The CTEPH team ensures that necessary diagnostic procedures are performed. A relatively low proportion of patients was assessed by the CTEPH team as operable and underwent surgery, which in survivors resulted in the best functional improvement. Although patients undergoing BPA(+MT) were older than patients treated with PEA, their survival was better than patients subjected to PEA or MT alone. The reviews of this paper are available via the supplemental material section.

Keywords: balloon pulmonary angioplasty; chronic thromboembolic pulmonary hypertension; multidisciplinary team; pulmonary endarterectomy; survival.

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Conflict of interest statement

Conflict of interest statement: SD, PB, EM, MK and AT report grants and personal fees from Actelion, MSD, Bayer and AOP Orphan. LC reports personal fees and conference participation fees from Actelion, MSD, Bayer, and AOP Orphan. The remaining authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Therapy for patients evaluated by the CTEPH team. BPA, balloon pulmonary angioplasty; CTEPH, chronic thromboembolic pulmonary hypertension; MT, medical therapy alone; PEA, pulmonary endarterectomy; RIO, riociguat; SIL, sildenafil; X, no medical therapy.
Figure 2.
Figure 2.
Survival after chronic thromboembolic pulmonary hypertension (CTEPH) team evaluation in patients treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty [(BPA) with or without medical therapy (MT)] and with MT alone (riociguat/sildenafil).
Figure 3.
Figure 3.
Change in World Health Organization (WHO) functional class in patients treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty [(BPA) with or without medical therapy (MT)] and MT alone (riociguat/sildenafil).
See this image and copyright information in PMC

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