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Pulmonary Vascular Disease |

An Analysis of Pulmonary Arterial Hypertension Targeted Medication Before and After Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Dina Bates, MD; Timothy Fernandes, MD; William Auger, MD; Kim Kerr, MD
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UC San Diego, San Diego, CA


Chest. 2015;148(4_MeetingAbstracts):1002A. doi:10.1378/chest.2277682
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Abstract

SESSION TITLE: Venous Thromboembolism Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The only definitive therapy for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary thromboendarterectomy at an experienced surgical center. The most recent guidelines on the care of CTEPH do not endorse pre-treatment with pulmonary arterial hypertension (PAH) targeted medications prior to surgery. We examined the last five years of our internal database to determine how many patients were referred on PAH therapy and how many patients received such therapy at discharge.

METHODS: We performed a retrospective analysis of all patients who underwent PTE at UC San Diego between January 2010 and December 2014. We evaluated the number of patients who were prescribed PAH targeted medications preoperatively and/or postoperatively upon hospital discharge.

RESULTS: Seven-hundred thirty-three patients were included in this analysis. Three-hundred twenty-five patients (44.3%) presented on PAH targeted medications preoperatively. While the majority of these patients were on a single-agent regimen (n=223, 68.6%), 102 (31.4%) patients were on combination therapy (n=93, 28.6% on two-drug therapy; n=9, 2.8% on three-drug therapy). Forty-six (14.2% of pre-treated) patients presented on parenteral therapy. Of the 325 patients who presented on PAH therapy, 4 (1.2%) patients died postoperatively, and 30 of the remaining 321 (9.3%) required PAH therapy upon discharge. Of the 408 patients who were not on PAH therapy prior to surgery, 6 (1.5%) died postoperatively, and 9 of the remaining 402 (2.2%) patients were discharged on PAH therapy. Of the 39 patients who required PAH therapy at discharge, only 2 (5.1%) were discharged on parenteral therapy, both of whom presented on parenteral therapy. In total, 44.3% of patients presented on PAH targeted medications prior to surgery, and only 5.4% of patients who survived were discharged on PAH therapy. Overall mortality during this 5-year period was 1.4%.

CONCLUSIONS: Despite the absence of data supporting the use of PAH targeted medications in operable CTEPH patients, nearly half of patients who underwent PTE at our institution over the past 5 years presented on such therapy. The majority of these pre-treated patients did not require PAH therapy upon hospital discharge.

CLINICAL IMPLICATIONS: This study underscores the considerable pulmonary hemodynamic benefit achieved with PTE surgery, enabling discontinuation of PAH targeted medications in the vast majority of operable CTEPH patients. The indications for the use of PAH specific bridging therapy require further investigation.

DISCLOSURE: Timothy Fernandes: Grant monies (from industry related sources): Actelion, Consultant fee, speaker bureau, advisory committee, etc.: Bayer William Auger: Grant monies (from industry related sources): Bayer Kim Kerr: Grant monies (from industry related sources): Bayer The following authors have nothing to disclose: Dina Bates

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