Evaluation and management of patients with chronic thromboembolic pulmonary hypertension - consensus statement from the ISHLT

Marc de Perrot¹, Deepa Gopalan², David Jenkins³, Irene M Lang⁴, Elie Fadel⁵, Marion Delcroix⁶, Raymond Benza⁷, Gustavo A Heresi⁸, Manreet Kanwar⁹, John T Granton¹⁰, Micheal McInnis¹¹, Frederikus A Klok¹², Kim M Kerr¹³, Joanna Pepke-Zaba¹⁴, Mark Toshner¹⁵, Anastasia Bykova¹⁶, Andrea M D' Armini¹⁷, Ivan M Robbins¹⁸, Michael Madani¹⁹, David McGiffin²⁰, Christoph B Wiedenroth²¹, Sebastian Mafeld²², Isabelle Opitz²³, Olaf Mercier⁵, Patricia A Uber²⁴, Robert P Frantz²⁵, William R Auger²⁶

Affiliations

¹ Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada. Electronic address: marc.deperrot@uhn.ca.
² Department of Radiology, Imperial College Healthcare NHS Trust, London & Cambridge University Hospital, Cambridge, UK.
³ National Pulmonary Endarterectomy Service, Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
⁴ Department of Cardiology, Pulmonary Hypertension Unit, Medical University of Vienna, Vienna, Austria.
⁵ Department of Thoracic and Vascular Surgery and Heart Lung Transplantation, Marie-Lannelongue Hospital, Paris Saclay University, Le Plessis-Robinson, France.
⁶ Clinical Department of Respiratory Diseases, Pulmonary Hypertension Centre, UZ Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU, Leuven, Belgium.
⁷ Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio.
⁸ Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
⁹ Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania.
¹⁰ Division of Respirology, University Health Network, Toronto, Ontario, Canada.
¹¹ Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.
¹² Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
¹³ University of California San Diego Medical Health, Division of Pulmonary Critical Care and Sleep Medicine, San Diego, California.
¹⁴ Pulmonary Vascular Disease Unit, Royal Papworth Hospital NHS foundation Trust, Cambridge, Cambridgeshire, UK.
¹⁵ Pulmonary Vascular Disease Unit, Royal Papworth Hospital NHS foundation Trust, Cambridge, Cambridgeshire, UK; Heart Lung Research Institute, University of Cambridge, Cambridge, UK.
¹⁶ Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
¹⁷ Unit of Cardiac Surgery, Intrathoracic-Trasplantation and Pulmonary Hypertension, University of Pavia, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
¹⁸ Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
¹⁹ Department of Cardiovascular and Thoracic Surgery, University of California San Diego, La Jolla, California.
²⁰ Department of Cardiothoracic Surgery, The Alfred Hospital and Monash University, Melbourne, VIC, Australia.
²¹ Department of Thoracic Surgery, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
²² Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.
²³ Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
²⁴ Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, Virginia.
²⁵ Department of Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, Minnesota.
²⁶ Pulmonary Hypertension and CTEPH Research Program, Temple Heart and Vascular Institute, Temple University, Lewis Katz School of Medicine, Philadelphia, Pennsylvania.

PMID: 34420851
DOI: 10.1016/j.healun.2021.07.020

Practice Guideline

Evaluation and management of patients with chronic thromboembolic pulmonary hypertension - consensus statement from the ISHLT

Marc de Perrot et al. J Heart Lung Transplant. 2021 Nov.

. 2021 Nov;40(11):1301-1326.

doi: 10.1016/j.healun.2021.07.020. Epub 2021 Aug 3.

Authors

Affiliations

¹ Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada. Electronic address: marc.deperrot@uhn.ca.
² Department of Radiology, Imperial College Healthcare NHS Trust, London & Cambridge University Hospital, Cambridge, UK.
³ National Pulmonary Endarterectomy Service, Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
⁴ Department of Cardiology, Pulmonary Hypertension Unit, Medical University of Vienna, Vienna, Austria.
⁵ Department of Thoracic and Vascular Surgery and Heart Lung Transplantation, Marie-Lannelongue Hospital, Paris Saclay University, Le Plessis-Robinson, France.
⁶ Clinical Department of Respiratory Diseases, Pulmonary Hypertension Centre, UZ Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU, Leuven, Belgium.
⁷ Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio.
⁸ Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
⁹ Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania.
¹⁰ Division of Respirology, University Health Network, Toronto, Ontario, Canada.
¹¹ Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.
¹² Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
¹³ University of California San Diego Medical Health, Division of Pulmonary Critical Care and Sleep Medicine, San Diego, California.
¹⁴ Pulmonary Vascular Disease Unit, Royal Papworth Hospital NHS foundation Trust, Cambridge, Cambridgeshire, UK.
¹⁵ Pulmonary Vascular Disease Unit, Royal Papworth Hospital NHS foundation Trust, Cambridge, Cambridgeshire, UK; Heart Lung Research Institute, University of Cambridge, Cambridge, UK.
¹⁶ Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
¹⁷ Unit of Cardiac Surgery, Intrathoracic-Trasplantation and Pulmonary Hypertension, University of Pavia, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
¹⁸ Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
¹⁹ Department of Cardiovascular and Thoracic Surgery, University of California San Diego, La Jolla, California.
²⁰ Department of Cardiothoracic Surgery, The Alfred Hospital and Monash University, Melbourne, VIC, Australia.
²¹ Department of Thoracic Surgery, Campus Kerckhoff of the University of Giessen, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
²² Division of Vascular and Interventional Radiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.
²³ Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
²⁴ Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, Virginia.
²⁵ Department of Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, Minnesota.
²⁶ Pulmonary Hypertension and CTEPH Research Program, Temple Heart and Vascular Institute, Temple University, Lewis Katz School of Medicine, Philadelphia, Pennsylvania.

PMID: 34420851
DOI: 10.1016/j.healun.2021.07.020

Abstract

ISHLT members have recognized the importance of a consensus statement on the evaluation and management of patients with chronic thromboembolic pulmonary hypertension. The creation of this document required multiple steps, including the engagement of the ISHLT councils, approval by the Standards and Guidelines Committee, identification and selection of experts in the field, and the development of 6 working groups. Each working group provided a separate section based on an extensive literature search. These sections were then coalesced into a single document that was circulated to all members of the working groups. Key points were summarized at the end of each section. Due to the limited number of comparative trials in this field, the document was written as a literature review with expert opinion rather than based on level of evidence.

Keywords: CTEPH; balloon pulmonary angioplasty; guidelines; pulmonary emboli; pulmonary hypertension; pulmonary thromboendarterectomy.

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Evaluation and management of patients with chronic thromboembolic pulmonary hypertension - consensus statement from the ISHLT

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Evaluation and management of patients with chronic thromboembolic pulmonary hypertension - consensus statement from the ISHLT

Authors

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Abstract

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Medical