Outcomes of Chronic Thromboembolic Pulmonary Hypertension After Balloon Pulmonary Angioplasty and Pulmonary Endarterectomy

Kohei Masaki; Kazuya Hosokawa; Kouta Funakoshi; Yu Taniguchi; Shiro Adachi; Takumi Inami; Jun Yamashita; Hitoshi Ogino; Ichizo Tsujino; Masaru Hatano; Nobuhiro Yaoita; Nobutaka Ikeda; Hiroto Shimokawahara; Nobuhiro Tanabe; Kayoko Kubota; Ayako Shigeta; Yoshito Ogihara; Koshin Horimoto; Yoshihiro Dohi; Takashi Kawakami; Yuichi Tamura; Koichiro Tatsumi; Kohtaro Abe; CTEPH AC Registry Study Group

doi:10.1016/j.jacasi.2024.05.007

Outcomes of Chronic Thromboembolic Pulmonary Hypertension After Balloon Pulmonary Angioplasty and Pulmonary Endarterectomy

JACC Asia. 2024 Jul 23;4(8):577-589. doi: 10.1016/j.jacasi.2024.05.007. eCollection 2024 Aug.

Authors

Kohei Masaki¹, Kazuya Hosokawa¹, Kouta Funakoshi², Yu Taniguchi³, Shiro Adachi⁴, Takumi Inami⁵, Jun Yamashita⁶, Hitoshi Ogino⁷, Ichizo Tsujino⁸, Masaru Hatano⁹, Nobuhiro Yaoita¹⁰, Nobutaka Ikeda¹¹, Hiroto Shimokawahara¹², Nobuhiro Tanabe¹³, Kayoko Kubota¹⁴, Ayako Shigeta¹⁵, Yoshito Ogihara¹⁶, Koshin Horimoto¹⁷, Yoshihiro Dohi¹⁸, Takashi Kawakami¹⁹, Yuichi Tamura²⁰, Koichiro Tatsumi¹⁵, Kohtaro Abe¹; CTEPH AC Registry Study Group

Collaborators

CTEPH AC Registry Study Group:
Takahiro Hiraide, Hidekazu Ikemiyagi, Yoshihiro Fukumoto, Satoshi Ikeda, Kimi Sato, Kazuhiro Kimura, Koichi Sugimoto, Hiroaki Kitaoka, Kenichi Tsujita, Akira Sato, Koichiro Sugimura, Masayuki Takamura, Akiyoshi Hashimoto, Hakuoh Konishi, Keiichi Odagiri

Affiliations

¹ Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
² Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan.
³ Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
⁴ Department of Cardiology, Nagoya University Hospital, Nagoya, Japan.
⁵ Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan.
⁶ Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
⁷ Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
⁸ Division of Respiratory and Cardiovascular Innovative Research, Hokkaido University, Sapporo, Japan.
⁹ Department of Cardiovascular Medicine, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan.
¹⁰ Department of Cardiovascular Medicine, Tohoku University Hospital, Sendai, Japan.
¹¹ Department of Cardiovascular Medicine, Toho University Medical Center Ohashi Hospital, Tokyo, Japan.
¹² Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
¹³ Department of Pulmonary Hypertension Center, Chibaken Saiseikai Narashino Hospital, Narashino, Japan.
¹⁴ Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
¹⁵ Department of Respirology, Chiba University Graduate School of Medicine, Chiba, Japan.
¹⁶ Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
¹⁷ Department of Cardiovascular Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan.
¹⁸ Department of Cardiovascular Medicine, Kure Kyosai Hospital, Kure, Japan.
¹⁹ Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
²⁰ Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan.

Abstract

Background: The contemporary outcome of balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) are unclear.

Objectives: This study aimed to clarify the characteristics and outcomes of CTEPH patients treated with BPA and PEA in Japan.

Methods: Among 1,270 participants enrolled between 2018 and 2023 in the CTEPH AC (Chronic Thromboembolic Pulmonary Hypertension Anticoagulant) registry, a Japanese nationwide CTEPH registry, 369 treatment-naive patients (BPA strategy: n = 313; PEA strategy: n = 56) and 690 on-treatment patients (BPA strategy: n = 561; PEA strategy: n = 129) were classified according to the presence of prior reperfusion therapy. Morbidity and mortality events (all-cause death, rescue mechanical reperfusion therapy, and/or initiation of parenteral pulmonary vasodilators), pulmonary hemodynamics, exercise tolerance, and relevant laboratory test results were evaluated.

Results: The BPA strategy was chosen in older patients than the PEA strategy (mean age, BPA vs PEA: 66.5 ± 12.6 years vs 62.5 ± 11.8 years; P = 0.028). Median follow-up period was 615 (Q1-Q3: 311-997) days in treatment-naive patients and 1,136 (Q1-Q3: 684-1,300) days in on-treatment patients. BPA strategy had as acceptable morbidity and mortality as PEA strategy (5-year morbidity and mortality event rate, BPA vs PEA: 10.2% [95% CI: 5.2%-19.5%] vs 16.1% [95% CI: 4.3%-50.6%] in treatment-naive patients; 9.7% [95% CI: 6.7%-13.8%] vs 6.9% [95% CI: 2.7%-17.3%] in on-treatment patients), with greater improvement of renal function; glomerular filtration rate in propensity score-matched population (difference between change: 4.9 [95% CI: 0.5-9.3] mL/min/1.73 m²; P = 0.030).

Conclusions: BPA strategy was more frequently chosen in older patients compared with PEA strategy and showed acceptable outcomes for efficacy with greater advantage for improvement in renal function. (Multicenter registry of chronic thromboembolic pulmonary hypertension in Japan; UMIN000033784).

Keywords: pulmonary embolism; pulmonary hypertension; registry; thromboembolism.