C Garcia-Alonso1, B Gerardin2, L Moisson2, O Mercier3, E Fadel3, P Brenot2. 1. Pôle d'imagerie thérapeutique et interventionnelle, hôpital Marie-Lannelongue, 133, avenue de la Resistance, 92350 Le Plessis-Robinson, France. Electronic address: c.garcia@hml.fr. 2. Pôle d'imagerie thérapeutique et interventionnelle, hôpital Marie-Lannelongue, 133, avenue de la Resistance, 92350 Le Plessis-Robinson, France. 3. Pôle chirurgie thoracique et vasculaire, hôpital Marie-Lannelongue, 133, avenue de la Resistance, 92350 Le Plessis-Robinson, France.
Abstract
AIM OF THE STUDY: To establish efficacy and security of invasive treatments for chronic thromboembolic pulmonary hypertension (CTEPH) in elderly patients (≥80 years old): pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA). PATIENTS AND METHODS: Between 2014 and 2017, 549 CTEPH patients were addressed to our hospital for PEA (364 patients) or BPA (225). From this total, patients 80 years old and over were: 17 treated by PEA and 21 by BPA. Demographic characteristics as well as hemodynamic parameters, results and complications were compared for both groups (Young - Y - versus Old - O). RESULTS: Elderly BPA patients presented a higher functional class (mean O: 3,16 versus Y: 2,73; P=0,001), with similar hemodynamics parameters compared with the younger patients. Indication for BPA in the elderly was the presence of comorbidities contraindicating surgery in 33% of cases vs. 9,3% in the younger group (P=0,005). Response to treatment was comparable in both groups with significant reductions of mPAP, PVR and improvement of functional class. Complications rate was alike between groups for hemoptysis, reperfusion lesions or mortality, with the exception of a higher incidence of contrast-induced nephropathy, without need for dialysis, in the elderly group (O: 8,4% versus 2,6%; P=0,010). Elderly PEA patients were more often male (O: 76,5% versus Y: 50,1%; P=0,034) and with a lower creatinine clearance (O: 57,6±13,4 versus Y: 72,2±21,2mL/min/m2; P=0,004). Functional class, hemodynamics, surgical times and in-hospital stay was similar between groups. There is a non-significant trend towards higher in-hospital mortality in the elderly group, CONCLUSIONS: In our experience, treatment of CPC PE in elderly patients, either by PEA or BPA is effective with acceptable complication rates.
AIM OF THE STUDY: To establish efficacy and security of invasive treatments for chronic thromboembolic pulmonary hypertension (CTEPH) in elderly patients (≥80 years old): pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA). PATIENTS AND METHODS: Between 2014 and 2017, 549 CTEPHpatients were addressed to our hospital for PEA (364 patients) or BPA (225). From this total, patients 80 years old and over were: 17 treated by PEA and 21 by BPA. Demographic characteristics as well as hemodynamic parameters, results and complications were compared for both groups (Young - Y - versus Old - O). RESULTS: Elderly BPApatients presented a higher functional class (mean O: 3,16 versus Y: 2,73; P=0,001), with similar hemodynamics parameters compared with the younger patients. Indication for BPA in the elderly was the presence of comorbidities contraindicating surgery in 33% of cases vs. 9,3% in the younger group (P=0,005). Response to treatment was comparable in both groups with significant reductions of mPAP, PVR and improvement of functional class. Complications rate was alike between groups for hemoptysis, reperfusion lesions or mortality, with the exception of a higher incidence of contrast-induced nephropathy, without need for dialysis, in the elderly group (O: 8,4% versus 2,6%; P=0,010). Elderly PEApatients were more often male (O: 76,5% versus Y: 50,1%; P=0,034) and with a lower creatinine clearance (O: 57,6±13,4 versus Y: 72,2±21,2mL/min/m2; P=0,004). Functional class, hemodynamics, surgical times and in-hospital stay was similar between groups. There is a non-significant trend towards higher in-hospital mortality in the elderly group, CONCLUSIONS: In our experience, treatment of CPC PE in elderly patients, either by PEA or BPA is effective with acceptable complication rates.
Authors: Samara M A Jansen; Anna E Huis In 't Veld; Peter Hans C G Tolen; Wouter Jacobs; H M Willemsen; Hans P Grotjohan; Marc Waskowsky; Jan van der Maten; Arno van der Weerdt; Romke Hoekstra; Ana J Pérez Matos; Maria J Overbeek; Sjoerd A Mollema; Lahssan H Hassan El Bouazzaoui; Joris W J Vriend; J Milena M Roorda; Ramon de Nooijer; Ivo van der Lee; A J Voogel; Johannes C Post; Thomas Macken; Jacqueline M Aerts; Marjo J T van de Ven; Heidi Bergman; Mirjam Bakker-de Boo; Roline C de Boer; Anton Vonk Noordegraaf; Frances S de Man; Harm Jan Bogaard Journal: J Am Heart Assoc Date: 2022-09-05 Impact factor: 6.106