Outcomes of Multidisciplinary Care at a Chronic Thromboembolic Pulmonary Hypertension Center
Christopher Malaisrie S, Chiu S, Schimmel D, Samant M, Avery R, Rahsepar A, Allen B, Raza Y, Freed B, Mylvaganam R, Cuttica MJ
Recent international guidelines recommend a multidisciplinary evaluation and care model for patients with chronic thromboembolic pulmonary hypertension (CTEPH), but there is a paucity of supporting data. The aim of this study was to describe the outcomes of a multidisciplinary team approach to the comprehensive care of CTEPH patients. This single-center cohort study enrolled 166 consecutive adult patients undergoing CTEPH treatment evaluation from 2016 to 2022 at a tertiary care, academic regional referral and comprehensive CTEPH center with pulmonary thromboendarterectomy (PTE) and balloon pulmonary angioplasty (BPA) capabilities. Patients underwent PTE, BPA, or medical management after consensus evaluation by a multidisciplinary team including pulmonary hypertension physicians, surgeons, interventional cardiologists, and radiologists. 86% (142/166) of patients underwent interventional therapies; 100 (60%) underwent PTE and 42 (25%) BPA. Of the 24 (14%) medically treated patients, 13 patients were offered but deferred intervention; 11 patients had non-intervenable disease. 30-day mortality in both PTE and BPA was 0%. 1- and 3-year survival was 99% and 96% for PTE, 100% and 93% for BPA, 79% and 79% for medical management. Patients who underwent PTE had the best hemodynamic response (∆PVR: PTE -278.8 ± 366.9 dyne/sec/cm5; BPA -15.9 ± 171.8 dyne/sec/cm5; medical -60.2 ± 233.1 dyne/sec/cm5; p = 0.001), largest improvement in Borg Dyspnea Scale; [PTE -1.0 (-2.8 to 0.0), BPA + 0.5 (-0.8 to 5.0), medical +1.0 (0.75 to 3.0), p = 0.01], and most improvement in NYHA functional class [% improving at least 1 functional class: PTE 64% (47/73), BPA 18% (5/28), medical 21% (4/19), p = 0.0004].
© 2025 The Author(s). Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.
Pulmonary circulation, 2025-04-24