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Patients with persistent/recurrent CTEPH after PTE

CTEPH may persist even after PTE

These patients would be categorized as WHO Group 4 patients1

  • Multiple reviews of the literature, including a systematic review of studies published from 1999 to 2010 that followed a total of 2,729 patients, show that residual pulmonary hypertension (PH) following pulmonary endarterectomy has been reported at rates of between 10% to 35%2-5

  • In a study that followed 469 patients diagnosed with CTEPH at any one of 5 PH centers in the UK, 198 patients underwent PTE (also called pulmonary endarterectomy [PEA]) and 162 survived the surgery to discharge6

    • These 162 patients had a repeat right heart catheterization (RHC) at 3 months: 70 (35%) had mPAP ≥25 mm Hg and PVR ≥240 dyn∙sec∙cm-5, indicating persistent PH

    • Compared with the 65% of patients (n=92) who did not have persistent PH following PTE surgery, those with persistent PH had significantly worse presurgical hemodynamics—mPAP 50.5 vs 46.5 mmHg; PVR: 1144 vs 934 dyn∙sec∙cm-5

    • However, there appeared to be little difference in survival rates between patients with persistent PH and those without persistent PH at 1 and 3 years6

  • A similar finding was reported from a study of 314 patients from a single UK center: Persistent PH after PTE appeared to have no significant effect on survival2

    • But patients with no persistent PH had fewer symptoms after surgery and better 6MWD than patients with persistent PH2

  • All patients diagnosed with CTEPH should receive lifelong anticoagulation1

10–35% have residual PH after PTE graphic

6MWD = 6-minute walking distance; mPAP = mean pulmonary arterial pressure; PVR = pulmonary vascular resistance.



1. Kim NH, Delcroix M, Jenkins DP, et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013;62(suppl D):D92-D99. 2. Freed DH, Thomson BM, Berman M, et al. Survival after pulmonary thromboendarterectomy: effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg. 2011;141(2):383-387. 3. Rahnavardi M, Yan TD, Cao C, et al. Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review. Ann Thorac Cardiovasc Surg. 2011;17(5):435-445. 4. Wittine LM and Auger WR. Curr Treat Options Cardiovasc Med. 2010;12:131-141. 5. Mayer E, Jenkins D, D’Armini A, et al. Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. J Thorac Cardiovasc Surg. 2011;141(3):702-710. 6. Condliffe R, Kiely DG, Gibbs JS, et al. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Resp Crit Care Med. 2008;177(10):1122-1127.