Chronic Thromboembolic Pulmonary Hypertension

Chronic Thromboembolic Pulmonary Hypertension

Pulmonary hypertension due to unresolved pulmonary emboli that narrow pulmonary arteries, also known as chronic thromboembolic pulmonary hypertension (CTEPH), is a deadly disease that can be effectively treated with a complex surgical procedure called pulmonary thromboendarterectomy (PTE). Since 2011, Cleveland Clinic has a multidisciplinary team dedicated to the evaluation and treatment of CTEPH patients. The team includes clinicians specializing in pulmonary medicine, cardiothoracic surgery, interventional radiology, chest radiology, nuclear medicine, cardiovascular medicine, anesthesiology, and critical care medicine.

Treatment options are expanding. Cleveland Clinic now offers PTE surgery to carefully selected patients with normal resting pulmonary hemodynamics who are symptomatic from chronic thromboembolic disease (CTED) as evidenced by invasive cardiopulmonary exercise testing.¹ ²

Pulmonary Thromboendarterectomy Experience (N = 318)

2011 – 2022

PTE = pulmonary thromboendarterectomy

During the past 28 years, 403 PTE surgeries have been performed at Cleveland Clinic. Between 1995 and 2010, operative mortality (ie, in-hospital deaths) was 11.6%. Between 2011 and 2022, surgical volume more than doubled and the operative mortality decreased to 2.5%, a rate comparable to or better than current published literature. ¹ ²

Balloon Pulmonary Angioplasty (BPA) Experience 2016 – 2022 (114 Patients and 462 Sessions)

2016 – 2022

For patients with inoperable CTEPH or residual pulmonary hypertension after PTE, medical therapy followed by balloon pulmonary angioplasty (BPA) has become the standard of care. Between 2016 and 2022 the team has treated 114 patients for a total of 462 BPA sessions.

BPA = balloon pulmonary angioplasty, PTE = pulmonary thromboendarterectomy

With more than 50 PTE surgeries in 2022, more than 30 unique patients treated with BPA and more than 100 BPA sessions in 2022, the Cleveland Clinic multidisciplinary CTEPH program meets the ideal volumes suggested by the guidelines for an expert CTEPH center. ³


  1. Jenkins DP, Tsui SS, Taghavi J, Kaul P, Ali J, Ng C. Pulmonary thromboendarterectomy-the Royal Papworth experience. Ann Cardiothorac Surg. 2022 Mar;11(2):128-132.
  2. de Perrot M, McRae K, Donahoe L, Abdelnour-Berchtold E, Thenganatt J, Granton J; Canadian CTEPH Working Group. Pulmonary endarterectomy in severe chronic thromboembolic pulmonary hypertension: the Toronto experience. Ann Cardiothorac Surg. 2022 Mar;11(2):133-1423.
  3. Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Rådegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2023 Jan 6;61(1):2200879