Inami Takumi, Kataoka Masaharu, Ando Motomi, Fukuda Keiichi, Yoshino Hideaki, Satoh Toru
Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
PLoS One. 2014 Apr 11;9(4):e94587. doi: 10.1371/journal.pone.0094587. eCollection 2014.
Pulmonary endarterectomy (PEA) is established for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Recently, percutaneous transluminal pulmonary angioplasty (PTPA) has been added for peripheral-type CTEPH, whose lesions exist in segmental, subsegmental, and more distal pulmonary arteries. A shift in clinical practice of interventional therapies occurred in 2009 (first mainly PEA, later PTPA). We examined the latest clinical outcomes of patients with CTEPH.
This study retrospectively included 136 patients with CTEPH. Twenty-nine were treated only with drug (Drug-group), and the other 107 underwent interventional therapies (Interventions-group) (39 underwent PEA [PEA-group] and 68 underwent PTPA [PTPA-group]). Total 213 PTPA sessions (failures, 0%; mortality rate, 1.47%) was performed in the PTPA-group (complications: reperfusion pulmonary edema, 7.0%; hemosputum or hemoptysis, 5.6%; vessel dissection, 2.3%; wiring perforation, 0.9%). Although baseline hemodynamic parameters were significantly more severe in the Interventions-group, the outcome after the diagnosis was much better in the Interventions-group than in the Drug-group (98% vs. 64% 5-year survival, p<0.0001). Hemodynamic improvement in the PEA-group was a 46% decrease in mean pulmonary arterial pressure (PAP) and a 49% decrease in total pulmonary resistance (TPR) (follow-up period; 74.7 ± 32.3 months), while those in the PTPA-group were a 40% decrease in mean PAP and a 49% decrease in TPR (follow-up period; 17.4 ± 9.3 months). The 2-year survival rate in the Drug-group was 82.0%, and the 2-year survival rate, occurrence of right heart failure, and re-vascularization rate in the PEA-group were 97.4%, 2.6%, and 2.8%, and those in the PTPA-group were 98.5%, 2.9%, and 2.9%, respectively.
The patients who underwent interventional therapies had better results than those treated only with drugs. The availability of both of these operative and catheter-based interventional therapies leads us to expect the dawn of a new era of therapeutic strategies for CTEPH.
肺动脉内膜剥脱术（PEA）已被确立用于治疗慢性血栓栓塞性肺动脉高压（CTEPH）。最近，经皮腔内肺动脉血管成形术（PTPA）已被用于治疗外周型CTEPH，其病变存在于段、亚段及更远端的肺动脉。2009年介入治疗的临床实践发生了转变（最初主要是PEA，后来是PTPA）。我们研究了CTEPH患者的最新临床结局。
本研究回顾性纳入了136例CTEPH患者。29例仅接受药物治疗（药物组），另外107例接受介入治疗（介入组）（39例接受PEA治疗[PEA组]，68例接受PTPA治疗[PTPA组]）。PTPA组共进行了213次PTPA手术（失败率为0%；死亡率为1.47%）（并发症：再灌注肺水肿7.0%；咯血或血痰5.6%；血管夹层2.3%；导丝穿孔0.9%）。尽管介入组的基线血流动力学参数明显更严重，但介入组诊断后的结局比药物组好得多（5年生存率98%对64%，p<0.0001）。PEA组血流动力学改善表现为平均肺动脉压（PAP）下降46%，总肺阻力（TPR）下降49%（随访期；74.7±32.3个月），而PTPA组分别为平均PAP下降40%，TPR下降49%（随访期；17.4±9.3个月）。药物组的2年生存率为82.0%，PEA组的2年生存率、右心衰竭发生率和再血管化率分别为97.4%、2.6%和2.8%，PTPA组分别为98.5%、2.9%和2.9%。
接受介入治疗的患者比仅接受药物治疗的患者结局更好。这两种手术和基于导管的介入治疗方法的可用性使我们期待CTEPH治疗策略新时代的曙光。
