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
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.