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Abstract：
OBJECTIVE: The recent developments in chronic thromboembolic pulmonary hypertension (CTEPH) are emphasizing the multidisciplinary team. We report on the changes in clinical practice following the development of a multidisciplinary team, based on our 7 years of experience.
METHODS: Multidisciplinary team was established in 2015 offering both balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) with technical upgrades by internal and external expertise. For operable cases, PEA was recommended as the primary treatment modality, followed by pulmonary angiography and right heart catheterization after 6 months to evaluate treatment effect and identify patients requiring further BPA. For patients with inoperable anatomy or high surgical risk, BPA was recommended as the initial treatment modality. Patient data and clinical outcomes were closely monitored.
RESULTS: The number of CTEPH treatments rapidly increased and postoperative survival improved after team development. Before the team, 38 patients were treated by PEA for 18 years; however, 125 patients were treated by PEA or BPA after the team for 7 years. The number of PEA performed was 64 and that of BPA 342 sessions. World Health Organization functional class I or II was achieved in 93% of patients. The patients treated with PEA was younger, male dominant, higher pulmonary artery pressure, and smaller cardiac index, than BPA-only patients. In-hospital death after PEA was only 1 case and none after BPA.
CONCLUSIONS: The balanced development of BPA and PEA through a multidisciplinary team approach proved synergistic in increasing the number of actively treated CTEPH patients and improving clinical outcomes.
METHODS: Multidisciplinary team was established in 2015 offering both balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) with technical upgrades by internal and external expertise. For operable cases, PEA was recommended as the primary treatment modality, followed by pulmonary angiography and right heart catheterization after 6 months to evaluate treatment effect and identify patients requiring further BPA. For patients with inoperable anatomy or high surgical risk, BPA was recommended as the initial treatment modality. Patient data and clinical outcomes were closely monitored.
RESULTS: The number of CTEPH treatments rapidly increased and postoperative survival improved after team development. Before the team, 38 patients were treated by PEA for 18 years; however, 125 patients were treated by PEA or BPA after the team for 7 years. The number of PEA performed was 64 and that of BPA 342 sessions. World Health Organization functional class I or II was achieved in 93% of patients. The patients treated with PEA was younger, male dominant, higher pulmonary artery pressure, and smaller cardiac index, than BPA-only patients. In-hospital death after PEA was only 1 case and none after BPA.
CONCLUSIONS: The balanced development of BPA and PEA through a multidisciplinary team approach proved synergistic in increasing the number of actively treated CTEPH patients and improving clinical outcomes.
摘要：
目的：慢性血栓栓塞性肺动脉高压（CTEPH）的最新进展正在强调多学科团队。我们报告了多学科团队发展后临床实践的变化，基于我们7年的经验。
方法：多学科团队成立于2015年，提供球囊肺血管成形术（BPA）和肺动脉内膜切除术（PEA），并通过内部和外部专业知识进行技术升级。对于可操作的情况，PEA被推荐为主要治疗方式，6个月后进行肺动脉造影和右心导管检查，以评估治疗效果并确定需要进一步BPA的患者。对于解剖结构不能手术或手术风险高的患者，建议将BPA作为初始治疗方式。密切监测患者数据和临床结果。
结果：团队发展后，CTEPH治疗的数量迅速增加，术后生存率提高。在团队之前，38例患者接受PEA治疗18年；然而，125例患者接受PEA或BPA治疗7年。执行的PEA的数量为64，BPA的数量为342。在93%的患者中实现了世界卫生组织的I级或II级功能。接受PEA治疗的患者更年轻，男性占优势,肺动脉压较高,和较小的心脏指数，而不是仅有BPA的患者。PEA后住院死亡仅1例，BPA后无一例。
结论：通过多学科团队方法，BPA和PEA的平衡发展被证明在增加积极治疗的CTEPH患者数量和改善临床结果方面具有协同作用。
方法：多学科团队成立于2015年，提供球囊肺血管成形术（BPA）和肺动脉内膜切除术（PEA），并通过内部和外部专业知识进行技术升级。对于可操作的情况，PEA被推荐为主要治疗方式，6个月后进行肺动脉造影和右心导管检查，以评估治疗效果并确定需要进一步BPA的患者。对于解剖结构不能手术或手术风险高的患者，建议将BPA作为初始治疗方式。密切监测患者数据和临床结果。
结果：团队发展后，CTEPH治疗的数量迅速增加，术后生存率提高。在团队之前，38例患者接受PEA治疗18年；然而，125例患者接受PEA或BPA治疗7年。执行的PEA的数量为64，BPA的数量为342。在93%的患者中实现了世界卫生组织的I级或II级功能。接受PEA治疗的患者更年轻，男性占优势,肺动脉压较高,和较小的心脏指数，而不是仅有BPA的患者。PEA后住院死亡仅1例，BPA后无一例。
结论：通过多学科团队方法，BPA和PEA的平衡发展被证明在增加积极治疗的CTEPH患者数量和改善临床结果方面具有协同作用。
