Feasibility of a noninvasive operability assessment in chronic thromboembolic pulmonary hypertension under real-world practice.

Adriana Rodriguez Chaverri, MD a, b, c, d, Yolanda Revilla Ostolaza, MD, PhD a, d, e, Maria Jesus Lopez-Gude, MD, PhD a, d, e , María Teresa Velazquez, MD a, d, e , Ines Ponz de Antonio a, b, c, d Sergio Alonso Charterina, MD, PhD a, d, e, Agustin Albarran Gonzalez-Trevilla, MD, PhD a, d, e, Marta Perez Nuñez, MD a, d, e , Jose Luis Perez Vela, MD a, d, Rafael Morales Ruiz, MD a, d, e, Juan F. Delgado Jimenez, MD, PhD a, b, c, d, e, Fernando Arribas Ynsaurriaga, MD, PhD a, b, c, d, Jose Maria Cortina, MD a, d, e y Pilar Escribano Subias, MD, PhD a, b, c, d, e

a Hospital Universitario Doce de Octubre, Madrid, Spain, b Fundación para la Investigación Biomédica del Hospital Universitario 12 de Octubre (FIBH12O), Madrid, Spain, c CIBER de enfermedades cardiovasculares (CIBERCV), Madrid, Spain. d ERN-Lung-Pulmonary Hypertension e  Centro de Referencia Nacional de Hipertensión Pulmonar Compleja, Spain,

*Correspondence: mariapilar.escribano@salud.madrid.org; Tel.: +34-91-3908000

Received: 16 September 2020; Accepted: 20 October 2020; Published: 21 October 2020

Abstract: This study aimed to evaluate the feasibility of a noninvasive operability assessment of chronic thromboembolic pulmonary hypertension (CTEPH) based on multidetector computed tomographic angiography (MCTA). Up to 176 patients were evaluated from January 2016 to April 2018. Throughout the first phase, the initial surgical decision was made based on MCTA with further analysis of pulmonary angiography (PA) in order to evaluate in which cases the initial decision was not modified by PA. During the second phase, PA was limited to patients judged inoperable based on MCTA or those whose assessment was not possible. Patients deemed operable (50%) based on MCTA along the first phase had been adequately classified, as PA did not modify the initial decision in all but one patient. Comparable results were obtained throughout the implementation phase. Regarding operated patients, the decision of operability was based solely on MCTA in 94% of those with level I disease, in 75% with level II, and 54% with level III. This approach enabled shorter periods of time to complete surgical assessment and the avoidance of PA-related morbidity. Baseline parameters, postoperative measures, and survival rates at 1 year after surgery were comparable in both phases. Noninvasive operability assessment is feasible in a subset of CTEPH patients and optimizes surgical candidacy evaluation.

Keywords: hypertension; pulmonary; pulmonary embolism; endarterectomy

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