Feasibility of a noninvasive operability assessment in chronic thromboembolic pulmonary hypertension under real-world practice.

Abstract Background – The development of an optimized assessment of operability in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is crucial. This study aimed to evaluate the feasibility of a noninvasive operability assessment of CTEPH based on multidetector computed tomographic angiography (MCTA). Methods –176 patients with CTEPH were evaluated from January 2016 to April 2018. Throughout the first phase, operability was assessed with MCTA and pulmonary angiography (PA): initial surgical decision was made based on MCTA with further analysis of PA to evaluate which cases initial decision was not modified by PA. During the second phase, PA was limited to patients judged inoperable based on MCTA or in those whose assessment was not possible. Results – Patients deemed operable (50%) based on MCTAalong the first phase, had been adequately classified, as PA did not modify the initial decision in all but one patient. Comparable results were obtained throughout the implementation phase, in which decision of operability was based on MCTA in 49% of the patients. Regarding operated patients, decision of operability had been based solely on MCTA in 94% of those with level I disease regarding intraoperative CTEPH classification; in 75% with level II disease and 54% with level III. This approach enabled shorter time periods to complete surgical assessment and the avoidance of PA-related morbidity. Baseline parameters, postoperative measures and survival rates at 1 year after surgerywere comparable in both phases. Conclusions - Noninvasive operability assessment is feasible in a subset of CTEPH patients and optimizessurgical candidacy evaluation.