Chronic thromboembolic pulmonary hypertension (CTEPH) is potentially curable by pulmonary endarterectomy (PEA), although a substantial proportion of patients develop residual pulmonary hypertension despite successful surgery. Currently, postoperative haemodynamic assessment relies on intermittent right heart catheterization, which does not provide information on the temporal evolution of pulmonary artery pressures during recovery.
The CTEPH-CardioMEMS study is a prospective, single-centre observational study evaluating the feasibility and clinical utility of continuous haemodynamic monitoring using the CardioMEMS™ system implanted intraoperatively during PEA. The primary objective is to characterize the postoperative trajectory of mean pulmonary artery pressure (mPAP), determine the time to haemodynamic stabilization, and explore the relationship between continuous pressure monitoring and clinical, echocardiographic, invasive haemodynamic and functional recovery.
Age ≥18 years. 2. Confirmed diagnosis of CTEPH according to current international guidelines. 3. Multidisciplinary indication for pulmonary endarterectomy. 4. Considered suitable for intraoperative CardioMEMS™ implantation. 5. Ability to comply with remote monitoring and scheduled follow-up. 6. Written informed consent.
Age <18 years.
Inability or unwillingness to provide written informed consent.
Contraindication to CardioMEMS™ implantation according to the manufacturer's instructions for use or investigator judgement.
Life expectancy <1 year due to a non-cardiopulmonary comorbidity.
All patients with a confirmed diagnosis of CTEPH evaluated at the multidisciplinary meeting of the Pulmonary Hypertension Unit (UHP) will be considered. In this meeting, treatment indication (PEA, BPA, and/or medical therapy) will be determined. During this session, candidates who are most likely to benefit from CardioMEMS™ implantation will be selected.
Cohort
Prospective
CardioMEMS
DeviceCardioMEMS™ implantation: The sensor will be implanted intraoperatively during pulmonary endarterectomy, under direct vision, into a subsegmental pulmonary artery branch with a minimum diameter of 7 mm. Implantation in this manner requires no additional percutaneous procedure and does not add to surgical risk; direct-vision placement allows accurate positioning within a thrombus-free segment. The device is intended to remain permanently in situ. All patients with CTEPH continue lifelong anticoagulation; although published device-related thrombosis/embolism rates are low (under 1 per 1000 implants), these data derive from cohorts without mandatory lifelong anticoagulation, and safety in this specific population is therefore a pre-specified objective of the study.7
Time to stabilization mPAP
The primary endpoint of the study will be the time from pulmonary endarterectomy (PEA) to stabilization of mean pulmonary artery pressure (mPAP), as assessed by continuous remote monitoring with the CardioMEMS™ system. Hemodynamic stabilization will be operationally defined as the first postoperative day on which the 7-day moving average of mPAP remains stable (variation \<10%) for three consecutive days, in the absence of any intercurrent clinical event or therapeutic intervention that could account for changes in pulmonary artery pressure.
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Hospital Universitario 12 de Octubre
Lead sponsor
Fundación para la Investigación Biomédica Hospital Universitario 12 de Octubre
Collaborator
Complutense
Collaborator
Universidad Complutense de Madrid
Collaborator
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