Effects of pulmonary endarterectomy and balloon pulmonary angioplasty in older adults with chronic thromboembolic pulmonary hypertension: A sub-analysis of the CTEPH AC registry.

Background: Invasive treatments for chronic thromboembolic pulmonary hypertension (CTEPH) include pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA). Both PEA and BPA demonstrate significant benefits for symptom relief, hemodynamic improvement, and overall patient outcomes. However, evidence of their efficacy in older adults remains limited. This study aimed to evaluate treatment efficacy-including exercise tolerance, hemodynamics, functional status-and clinical outcomes in CTEPH patients aged ≥70 years who underwent PEA or BPA. Methods: Among 1,527 patients in the CTEPH AntiCoagulants Registry, we selected those aged 70 years or older, including 25 who underwent PEA during follow-up and 210 who received BPA. We evaluated the World Health Organization functional class (WHO FC), a measure of subjective symptoms, along with exercise capacity, hemodynamic parameters, and clinical outcomes. Results: At baseline, BPA patients were older (P = 0.003) and tended to have lower body weight (P = 0.069) than those undergoing PEA. At a median follow-up of ∼2 years, BPA significantly improved six-minute walk distance and cardiac index, and reduced mean pulmonary artery pressure and pulmonary vascular resistance, with effects comparable to PEA after adjusting for age, sex, and body mass index (all adjusted P > 0.10). However, improvement in WHO FC was more frequent with BPA and became significant after covariate adjustment (adjusted P = 0.035). Adverse event rates were infrequent and similar between the two groups (all P > 0.10). Conclusions: In adults aged ≥ 70 years with CTEPH, BPA improved hemodynamics, exercise capacity, and outcomes comparable to PEA, but with greater WHO FC improvement. Further randomized trials in older adults are warranted. Clinical trial registration number: UMIN Clinical Trials Registry (identifier UMIN 000033784).