Impact of Initiating Combined Multimodal Therapy on Surgical Referral and Postoperative Outcomes in Patients with Chronic Thromboembolic Pulmonary Hypertension
Seance of wednesday 05 november 2025 (Progrès et Innovations en Chirurgie Thoracique)
DOI number : 10.26299/yvjk-cm63/emem.2025.45.02
Abstract
Objectives:
Chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), or pulmonary hypertension-specific pharmacotherapy (PHSP). The combination of these modalities has shown promising results in complex cases. This study aimed to evaluate whether the introduction of a combined multimodal therapy (CMT) strategy has influenced the characteristics of patients referred for PEA and improved postoperative outcomes.
Methods:
This prospective registry-based study included all patients with CTEPH who underwent PEA at the French National Reference Center before (2015–2016) and after (2022–2023) the implementation of CMT in 2017. The years 2017–2019 were considered part of the learning curve, and the program was largely suspended during the COVID-19 pandemic (2020–2021). Preoperative clinical and hemodynamic profiles, perioperative characteristics, and all-cause mortality were compared between groups using t-tests or chi-square tests.
Results:
Patients operated on during the CMT era had significantly less severe preoperative profiles compared to those in the pre-CMT era, with lower pulmonary vascular resistance (PVR: 4.8 vs. 8 Wood units; p < 0.0001) and higher six-minute walk distance (6MWD: 455 vs. 385 meters; p < 0.0001). However, at baseline—prior to PHSP and BPA—patients in the CMT group had similar clinical and hemodynamic characteristics to those in the pre-CMT group (PVR: 9 vs. 8; p = 0.07 and 6MWD: 412 vs. 385; p = 0.09). Postoperative outcomes were significantly improved in the CMT era, with lower 90-day mortality (1.2% vs. 4.8%; p = 0.03), reduced ECMO use (1.2% vs. 9%; p < 0.001), fewer days of mechanical ventilation (0 vs. 2; p < 0.001), and shorter hospital stays (14 vs. 19 days; p < 0.001).
Conclusion:
The implementation of a combined multimodal therapy strategy has led to referral of patients with less severe CTEPH for surgery and better pre-operative managment, resulting in improved preoperative conditions and significantly better postoperative outcomes. These findings support the integration of CMT into the standard management of CTEPH to optimize surgical results and patient recovery
Chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), or pulmonary hypertension-specific pharmacotherapy (PHSP). The combination of these modalities has shown promising results in complex cases. This study aimed to evaluate whether the introduction of a combined multimodal therapy (CMT) strategy has influenced the characteristics of patients referred for PEA and improved postoperative outcomes.
Methods:
This prospective registry-based study included all patients with CTEPH who underwent PEA at the French National Reference Center before (2015–2016) and after (2022–2023) the implementation of CMT in 2017. The years 2017–2019 were considered part of the learning curve, and the program was largely suspended during the COVID-19 pandemic (2020–2021). Preoperative clinical and hemodynamic profiles, perioperative characteristics, and all-cause mortality were compared between groups using t-tests or chi-square tests.
Results:
Patients operated on during the CMT era had significantly less severe preoperative profiles compared to those in the pre-CMT era, with lower pulmonary vascular resistance (PVR: 4.8 vs. 8 Wood units; p < 0.0001) and higher six-minute walk distance (6MWD: 455 vs. 385 meters; p < 0.0001). However, at baseline—prior to PHSP and BPA—patients in the CMT group had similar clinical and hemodynamic characteristics to those in the pre-CMT group (PVR: 9 vs. 8; p = 0.07 and 6MWD: 412 vs. 385; p = 0.09). Postoperative outcomes were significantly improved in the CMT era, with lower 90-day mortality (1.2% vs. 4.8%; p = 0.03), reduced ECMO use (1.2% vs. 9%; p < 0.001), fewer days of mechanical ventilation (0 vs. 2; p < 0.001), and shorter hospital stays (14 vs. 19 days; p < 0.001).
Conclusion:
The implementation of a combined multimodal therapy strategy has led to referral of patients with less severe CTEPH for surgery and better pre-operative managment, resulting in improved preoperative conditions and significantly better postoperative outcomes. These findings support the integration of CMT into the standard management of CTEPH to optimize surgical results and patient recovery