Key result
Pulmonary endarterectomy is the curative standard of care for surgically accessible chronic thromboembolic pulmonary disease, while balloon pulmonary angioplasty is an effective alternative for inoperable patients.
Why the study?
While pulmonary endarterectomy is curative for chronic thromboembolic pulmonary disease, many patients have prohibitive surgical risk or surgically inaccessible disease, warranting other interventions such as balloon pulmonary angioplasty and medical therapy.
This review highlights that while pulmonary endarterectomy remains the curative gold standard for CTEPH, balloon pulmonary angioplasty and medical therapies provide crucial options for inoperable patients or those with residual disease.
Chronic thromboembolic pulmonary disease (CTEPD) is characterized by unresolved clot burden in large pulmonary arteries, obstructive disease in smaller arteries, and increased downstream clot burden. This occurs in the setting of abnormal fibrinolysis or hematological disorders. Up to 50% of patients in some studies are unaware of a self-history of a deep venous thrombosis or pulmonary embolism. Ultimately, they present with symptoms of pulmonary hypertension (PH), which can result in right heart failure (RHF). Pulmonary endarterectomy (PEA) is curative, though many patients have prohibitive surgical risk or surgically inaccessible disease, warranting other interventions such as balloon pulmonary angioplasty (BPA) and medical therapy. Rarely, other treatment options may be implemented. We focus this review on PEA and BPA, with an overview of the history of CTEPD and the evolution of these procedures. We will briefly discuss other treatment modalities.
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Kassis‐George et al. (2023) conducted a review in Chronic thromboembolic pulmonary disease. Pulmonary endarterectomy and balloon pulmonary angioplasty was evaluated. Pulmonary endarterectomy is the curative standard of care for surgically accessible chronic thromboembolic pulmonary disease, while balloon pulmonary angioplasty is an effective alternative for inoperable patients.
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