Outcomes of Multidisciplinary Care at a Chronic Thromboembolic Pulmonary Hypertension Center

Abstract

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].