Interventional and surgical modalities of treatment for pulmonary arterial hypertension

Walter Klepetko, Eckhard Mayer, Julio Sandoval, Elbert P. Trulock, Jean Luc Vachiery, Phillippe Dartevelle, Joanna Pepke-Zaba, Stuart W. Jamieson, Irene Lang, Paul Corris

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197 Scopus citations

Abstract

Beyond medical therapy, different interventional and surgical approaches exist for treatment of pulmonary arterial hypertension (PAH). Atrial septostomy has been applied in patients with lack of response to medical therapy in the absence of other surgical treatment options. With growing experience, procedure-related death rates have been reduced to 5.4%, and the most suitable patient group has been identified among patients with a mean right atrial pressure between 10 and 20 mm Hg. Pulmonary endarterectomy is the accepted form of treatment for patients with chronic thromboembolic pulmonary hypertension. Establishing the diagnosis and the classification of the type of lesions by pulmonary angiography is crucial for optimal patient selection. Perioperative mortality rates have been reduced to <10% in experienced centers, and the hemodynamic improvement is dramatic and sustained. Lung and heart-lung transplantation remains the procedure of choice for patients unsuitable for other treatment modalities. Timing of the procedure is difficult because waiting times vary between centers and usually are in a high range. Early referral of patients unresponsive to other treatment forms is therefore of importance to avoid transplantation of patients with established significant comorbidity. The survival rate during the first five years after transplantation for PAH is intermediate among the lung diseases, lower than chronic obstructive pulmonary disease but higher than idiopathic pulmonary fibrosis.

Original languageEnglish
Pages (from-to)S73-S80
JournalJournal of the American College of Cardiology
Volume43
Issue number12 SUPPL.
DOIs
StatePublished - Jun 16 2004

Keywords

  • AS
  • BBAS
  • BDAS
  • CTEPH
  • NYHA
  • New York Heart Association
  • PA
  • PAH
  • atrial septostomy
  • balloon dilation atrial septostomy
  • blade balloon atrial septostomy
  • chronic thromboembolic pulmonary hypertension
  • mRAP
  • mean right atrial pressure
  • pulmonary artery

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