Persistent or Recurrent Pulmonary Hypertension After PEA in Operable CTEPH
Clinical Scenario
This protocol addresses patients with chronic thrombo-embolic pulmonary hypertension who have fibrotic obstructions within pulmonary arteries accessible by surgery — patients for whom pulmonary endarterectomy (PEA) was performed as the primary intervention but who continue to have residual or recurrent pulmonary hypertension.
Why This Step — Prior Treatment Did Not Achieve Targets
The prior intervention — pulmonary endarterectomy (PEA), a complete bilateral endarterectomy of the pulmonary arteries — aimed to achieve a good functional class (WHO-FC I–II) and normalization or near-normalization of haemodynamics at rest, confirmed by right heart catheterization at 3–6 months post-procedure. When those goals are not reached, escalation to a further treatment approach is indicated.
Treatment Approach (Partial Overview)
For patients with persistent or recurrent pulmonary hypertension after PEA, a multimodality approach is a guiding principle — the complete structured regimen is detailed in the full protocol.
Treatment Goals
The target is achieving a good functional class (WHO-FC I–II) and normalization or near-normalization of haemodynamics at rest, as assessed by right heart catheterization 3–6 months after the procedure.
References
DOI: 10.1093/eurheartj/ehac237
- PEA is recommended as the treatment of choice for patients with CTEPH and fibrotic obstructions within pulmonary arteries accessible by surgery
- Surgical PEA is the treatment of choice for patients with accessible PA lesions.
- A multimodality approach should be considered for patients with persistent PH after PEA and for patients with inoperable CTEPH
- Most experts accept achieving a good functional class (WHO-FC I-II) and/or normalization or near normalization of haemodynamics at rest, obtained at RHC 3-6 months post-procedure (PEA or last BPA), and improvement in quality of life.
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