Pulmonary endarterectomy achieved the greatest improvement in pulmonary vascular resistance (9.8 to 3.9 WU) compared to balloon pulmonary angioplasty and sGC stimulators (all p<0.05).
Observational (n=74)
Yes
Do pulmonary endarterectomy, balloon pulmonary angioplasty, and sGC stimulator monotherapy improve clinical and risk profiles in patients with CTEPH?
Pulmonary endarterectomy remains the most effective treatment for CTEPH, achieving the greatest hemodynamic and functional improvements, while balloon pulmonary angioplasty and sGC stimulators provide smaller but significant benefits.
p-value: p=< 0.05
Abstract Background Chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), medical therapy, or a combination. While lesion localization and patient characteristics guide treatment selection, the comparative impact of these strategies on clinical outcomes and risk status remains insufficiently defined. Purpose To compare the efficacy, safety, and impact on clinical and risk profiles of PEA, BPA, and soluble guanylate cyclase (sGC) stimulator monotherapy in patients with CTEPH during 18 months of follow-up, aiming to inform personalized and preventive management strategies. Methods This retrospective multicenter study included patients with confirmed CTEPH treated with PEA, BPA, or sGC stimulator monotherapy, with baseline and follow-up data collected from two expert centers over 18 months. Diagnosis was established by right heart catheterization (RHC), ventilation/perfusion scanning, and pulmonary angiography. Changes in clinical parameters, outcomes, and risk status were assessed at baseline and follow-up using risk stratification methods adapted from pulmonary arterial hypertension (PAH). Results Between September 2010 and January 2021, 74 patients were included: 26 (35.1%) underwent PEA, 15 (20.3%) BPA, and 33 (44.6%) received sGC stimulator monotherapy. At repeat RHC, pulmonary vascular resistance improved most after PEA (9.8 ± 6.5 to 3.9 ± 2.0 Wood units WU), followed by BPA (10.1 ± 3.5 to 5.4 ± 3.3 WU) and sGC stimulator therapy (12.8 ± 5.6 to 9.9 ± 4.9 WU) (all p 0.05). Improvements in 6-minute walk distance, NT-proBNP, echocardiographic parameters, WHO functional class, and risk status were greatest with PEA, followed by BPA and sGC stimulator monotherapy. Conclusions PEA remains the most effective treatment for CTEPH, achieving marked hemodynamic and functional improvements with low perioperative mortality in experienced centers. BPA is generally safe and effective but produces smaller benefits compared with PEA. sGC stimulator monotherapy provides modest hemodynamic and functional gains with a favorable safety profile. Risk stratification approaches adapted from PAH appear applicable to CTEPH and may aid early identification of residual or progressive disease but merit validation in larger-scale studies. Long-term outcomes of BPA and sequential or combination strategies warrant continued investigation.
Kramer et al. (Mon,) conducted a observational in Chronic thromboembolic pulmonary hypertension (CTEPH) (n=74). Pulmonary endarterectomy (PEA) vs. Balloon pulmonary angioplasty (BPA) or sGC stimulator monotherapy was evaluated on Pulmonary vascular resistance (p=< 0.05). Pulmonary endarterectomy achieved the greatest improvement in pulmonary vascular resistance (9.8 to 3.9 WU) compared to balloon pulmonary angioplasty and sGC stimulators (all p<0.05).