TY - JOUR T1 - Chronic thromboembolic pulmonary hypertension at the crossroad JF - European Respiratory Journal JO - Eur Respir J SP - 1230 LP - 1232 DO - 10.1183/09031936.00037114 VL - 43 IS - 5 AU - Marius M. Hoeper Y1 - 2014/05/01 UR - http://erj.ersjournals.com/content/43/5/1230.abstract N2 - Chronic thromboembolic pulmonary hypertension (CTPEH) is one of the few forms of pulmonary hypertension for which we have a clear and undisputed solution, i.e. pulmonary endarterectomy (PEA). In the vast majority of patients, PEA markedly improves or even cures the disease [1]. Over the years, surgeons have continuously improved their skills and are now reaching beyond the level of the subsegmental vessels. Patients, who would have been considered inoperable a couple of years ago, are now undergoing surgery and are surviving and doing well! In San Diego (CA, USA), considered the epicentre of the PEA universe, the in-hospital mortality for the most recent 500 surgeries in this field was 2.2% with no mortalities among the last 260 procedures; despite the patients presenting with more peripheral disease and more co-morbidities [2]. Recent reports from other centres are comparable [3, 4].So, why even think about alternative therapies? Well, first of all, some patients are not operable, not even in the most experienced of centres. Occasionally, small-vessel disease dominates the picture and in such cases PEA is not a good option given a high risk of persistent pulmonary hypertension and a high mortality [5–7]. In fact, even after successful PEA, up to … ER -