Nationwide trends of balloon pulmonary angioplasty and pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension (2012-2019).

Autor: Vohra AS; Department of Medicine, Division of Cardiology Weill Cornell Medical College New York New York USA., Olonoff DA; SUNY Upstate Medical School Syracuse New York USA., Ip A; Department of Medicine, Division of Cardiology Weill Cornell Medical College New York New York USA., Kirtane AJ; Department of Medicine, Division of Cardiology Columbia University Irving Medical Center New York New York USA., Steinberg Z; Department of Medicine, Division of Cardiology University of Washington Seattle Washington USA., Horn E; Department of Medicine, Division of Cardiology Weill Cornell Medical College New York New York USA., Krishnan U; Department of Medicine, Division of Cardiology Weill Cornell Medical College New York New York USA., Reisman M; Department of Medicine, Division of Cardiology Weill Cornell Medical College New York New York USA., Bergman G; Department of Medicine, Division of Cardiology Weill Cornell Medical College New York New York USA., Wong SC; Department of Medicine, Division of Cardiology Weill Cornell Medical College New York New York USA., Feldman DN; Department of Medicine, Division of Cardiology Weill Cornell Medical College New York New York USA., Kim LK; Department of Medicine, Division of Cardiology Weill Cornell Medical College New York New York USA., Singh HS; Department of Medicine, Division of Cardiology Weill Cornell Medical College New York New York USA.
Jazyk: angličtina
Zdroj: Pulmonary circulation [Pulm Circ] 2024 May 09; Vol. 14 (2), pp. e12374. Date of Electronic Publication: 2024 May 09 (Print Publication: 2024).
DOI: 10.1002/pul2.12374
Abstrakt: Chronic thromboembolic pulmonary hypertension (CTEPH) is a sequela of a pulmonary embolus that occurs in approximately 1%-3% of patients. Pulmonary thromboendoarterectomy (PTE) can be a curative procedure, but balloon pulmonary angioplasty (BPA) has emerged as an option for poor surgical candidates. We used the National Inpatient Sample to query patients who underwent PTE or BPA between 2012 and 2019 with CTEPH. The primary outcome was a composite of in-hospital mortality, myocardial infarction, stroke, tracheostomy, and prolonged mechanical ventilation. Outcomes were compared between low- and high-volume centers, defined as 5 and 10 procedures per year for BPA and PTE, respectively. During our study period, 870 BPA and 2395 PTE were performed. There was a 328% relative increase in the number of PTE performed during the study period. Adverse events for BPA were rare. There was an increase in the primary composite outcome for low-volume centers compared to high-volume centers for PTE (24.4% vs. 12.1%, p  = 0.003). Patients with hospitalizations for PTE in low-volume centers were more likely to have prolonged mechanical ventilation (20.0%% vs. 7.2%, p  < 0.001) and tracheostomy (7.8% vs. 2.6%, p  = 0.017). In summary, PTE rates have been rising over the past 10 years, while BPA rates have remained stable. While adverse outcomes are rare for BPA, patients with hospitalizations at low-volume centers for PTE were more likely to have adverse outcomes. For patients undergoing treatment of CTEPH with BPA or PTE, referral to high-volume centers with multidisciplinary teams should be encouraged for optimal outcomes.
Competing Interests: A. V.: Grant funding from the New York Academy of Medicine; A. K.: Institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Amgen, CSI, Philips, ReCor Medical, Neurotronic, Biotronik, Chiesi, Bolt Medical, Magenta Medical, Canon, SoniVie, Shockwave Medical, and Merck. In addition to research grants, institutional funding includes fees paid to Columbia University and/or Cardiovascular Research Foundation for consulting and/or speaking engagements in which Dr. Ajay J. Kirtane controlled the content. Personal: Consulting from IMDS; Travel Expenses/Meals from Medtronic, Boston Scientific, Abbott Vascular, CSI, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron; Z. S.: Consulting feeds from Medtronic and Abbott Vascular. The remaining authors declare no conflict of interest.
(© 2024 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)
Databáze: MEDLINE
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