Korean Circ J.  2024 Jul;54(7):409-421. 10.4070/kcj.2024.0021.

Programmed Follow-up and Quality Control of Treatment Techniques Enhance Chronic Thromboembolic Pulmonary Hypertension Management: Lessons From a Multidisciplinary Team

• Park TK
• Chang SA
• Yang JH
• Kwon W
• Kim MY
• Cho YS
• Park HY
• Jeong DS
• Kim H
• Kim Dk

• KMID: 2557981
• DOI: http://doi.org/10.4070/kcj.2024.0021

Abstract

Background and Objectives
The recent developments in chronic thromboembolic pulmonary hypertension (CTEPH) are emphasizing the multidisciplinary team. We report on the changes in clinical practice following the development of a multidisciplinary team, based on our 7 years of experience.
Methods
Multidisciplinary team was established in 2015 offering both balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) with technical upgrades by internal and external expertise. For operable cases, PEA was recommended as the primary treatment modality, followed by pulmonary angiography and right heart catheterization after 6 months to evaluate treatment effect and identify patients requiring further BPA. For patients with inoperable anatomy or high surgical risk, BPA was recommended as the initial treatment modality. Patient data and clinical outcomes were closely monitored.
Results
The number of CTEPH treatments rapidly increased and postoperative survival improved after team development. Before the team, 38 patients were treated by PEA for 18 years; however, 125 patients were treated by PEA or BPA after the team for 7 years. The number of PEA performed was 64 and that of BPA 342 sessions. World Health Organization functional class I or II was achieved in 93% of patients. The patients treated with PEA was younger, male dominant, higher pulmonary artery pressure, and smaller cardiac index, than BPA-only patients. In-hospital death after PEA was only 1 case and none after BPA.
Conclusions
The balanced development of BPA and PEA through a multidisciplinary team approach proved synergistic in increasing the number of actively treated CTEPH patients and improving clinical outcomes.

Keyword

Pulmonary thromboembolism; Pulmonary heart disease; Pulmonary hypertension; Quality control; Treatment outcome

Figure

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  Figure 1 Number of CTEPH patients before and after CTEPH team development. The annual number of PEA cases is represented by the blue bar, while the orange bar represents the annual number of BPA cases.BPA = balloon pulmonary angioplasty; CTEPH = chronic thromboembolic pulmonary hypertension; PEA = pulmonary endarterectomy.

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  Figure 2 Details of treatment of chronic thromboembolic pulmonary hypertension patients after multidisciplinary team development.BPA = balloon pulmonary angioplasty; PEA = pulmonary endarterectomy.

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  Figure 3 The reasons for performing BPA.BPA = balloon pulmonary angioplasty; PEA = pulmonary endarterectomy; PH = pulmonary hypertension.

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  Figure 4 Functional improvement after treatment in overall population and by treatment strategy.BPA-only = patients who were treated exclusively with balloon pulmonary angioplasty without surgery; PEA-based = patients who were treated with pulmonary endarterectomy with or without balloon pulmonary angioplasty.

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