Long-term outcomes of surgery for chronic thromboembolic pulmonary hypertension compared with medical therapy at a single Korean center

• Published in: The Korean journal of internal medicine Vol. 32; no. 5; pp. 855 - 864
• Main Authors: Kim, Soo Han, Lee, Jae Won, Ahn, Jung-Min, Kim, Dae-Hee, Song, Jong-Min, Lee, Sang-Do, Lee, Jae Seung
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Association of Internal Medicine 01-09-2017; 대한내과학회
• Subjects: Adult; Aged; Antihypertensive Agents - adverse effects; Antihypertensive Agents - therapeutic use; Arterial Pressure - drug effects; Chi-Square Distribution; Chronic Disease; Endarterectomy - adverse effects; Female; Humans; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Hypertension, Pulmonary - therapy; Kaplan-Meier Estimate; Linear Models; Male; Middle Aged; Multivariate Analysis; Original; Proportional Hazards Models; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - drug effects; Pulmonary Artery - physiopathology; Pulmonary Artery - surgery; Pulmonary Embolism - complications; Pulmonary Embolism - diagnosis; Pulmonary Embolism - physiopathology; Pulmonary Embolism - therapy; Retrospective Studies; Risk Factors; Seoul; Time Factors; Treatment Outcome; 내과학; Pulmonary embolism; Survival; Surgery; Hypertension, pulmonary; Korea
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2016.049

Pulmonary endarterectomy (PEA) is the gold standard for treating chronic thromboembolic pulmonary hypertension (CTEPH) in Western countries. The aim of this study was to investigate the long-term outcomes of performing PEA on CTEPH patients in comparison with medical therapy at a single Korean center.
This retrospective study included 88 CTEPH patients. These patients were classified into the PEA group (n = 37) or non-PEA group (i.e., medical therapy; n = 51). The clinical characteristics, hemodynamic data, and long-term survival rates were compared. Independent prognostic factors for CTEPH were also investigated.
CTEPH was not associated with either gender, and the mean age at diagnosis was 53.3 ± 13.7 years. Echocardiography revealed that the mean peak velocity of the tricuspid regurgitation jet was 4.2 ± 0.7 m/sec and the mean pulmonary arterial pressure was 51.7 ± 15.1 mmHg. The PEA and non-PEA groups demonstrated no significant differences, except in terms of the right ventricular end-diastolic diameter. The survival rates of the PEA group were significantly higher than the non-PEA group at 1, 3, 5, and 10 years (
= 0.032). Multivariate analyses indicated that World Health Organization class IV and PEA were significant predictors of poorer and better outcomes, respectively.
PEA demonstrates more favorable effects on long-term survival than medical therapy in Korean CTEPH patients who were considered operable.