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More options for chronic thromboembolic pulmonary hypertension treatment – balloon pulmonary angioplasty is affirming it’s role
Session:
Comunicações Orais - Sessão 10 - Hipertensão Pulmonar Tromboembólica Crónica
Speaker:
Bárbara Marques Ferreira
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Bárbara Marques Ferreira; Filipa Ferreira; Rita Calé; Sofia Alegria; Mário Ferraz; Débora Repolho; Pedro Santos; Otília Simões; Alexandra Briosa; João Grade Santos; Mariana Martinho; Diogo Cunha; Nazar Ilchysnyn; João Luz; Oliveira Baltazar; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background: </strong>Chronic thromboembolic pulmonary hypertension (CTEPH) has bad prognosis without treatment. Pulmonary endarterectomy (PEA) is a surgical procedure with curative potential for these patients (pts) and is the first line therapy when feasible. However, in this last decade, balloon pulmonary angioplasty (BPA) had increasing evidence of its efficacy and safety and it’s gaining importance as a treatment strategy particularly in inoperable pts or in pts with residual or recurrent disease after surgery, reflected in the recently published guidelines.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>Compare different treatment strategies for pts with diagnose of CTEPH.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methodology: </strong>Longitudinal retrospective study, that included all CTEPH pts followed in a referral center for pulmonary hypertension (PH). Baseline clinical data including plasma biomarkers, transthoracic echocardiogram, 6 minutes walking test (6MWT) and right heart catheterization were collected. We created 3 groups depending on treatment strategy (PEA vs BPA vs pulmonary vasodilators) and clinical follow up and outcomes (death) were accessed. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>We included 66 pts with CTEPH (68% female, mean age 59.97±15.28 years). 77.3% were in WHO functional class ≥III. All the pts were presented to multidisciplinary team for consideration for PEA but only 33 (50%) were submitted to surgery either because they were technically inoperable (42.4%), had high risk for surgery (1.5%) or pts refused surgery (6.1%). From the other 33 pts that didn’t have surgery, 13 pts completed BPA program and 20 pts were treated conservatively with pulmonary vasodilators. Differences between the groups are represented in Table 1.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Pre-treatment with pulmonary vasodilator therapies was done in 12.1% of pts assigned for PEA and 78.5% of pts assigned for BPA (p<0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">6 months after treatment, residual pulmonary hypertension (defined as pulmonary vascular resistance of 4 WoodUnits) was present in 25.8% of PEA group, 25% of BPA group and 91% of medical therapy. Additionally, 5 pts performed BPA after PEA for treatment of residual pulmonary hypertension. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Kaplan Meier survival curves showed that pts submitted to interventions (PEA or BPA) had better survival compared to medical therapy (Log-rank test p<0.001), but the best survival curve is for pts submitted to BPA (Figure 1).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>There are three different treatment strategies available for CTEPH. Interventional (either BPA or PEA) had better survival in our patient population compared to medical therapy alone, presenting BPA the best survival curve in our population. Randomized studies are needed to compare prognostic benefit of both interventional strategies.</span></span></p>
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