Pulmonary Thromboendarterectomy Without Circulatory Arrest

Kynta, Reuben Lamiaki; Rawat, Sanjib; Mandal, Mrinal; Saikia, Manuj Kumar

doi:10.21470/1678-9741-2020-0534

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Always with regard to technical aspects, alternative techniques to HCA have been developed over the years, such as selective cerebral perfusion or models of left and right heart chamber venting. Even though PEA on HCA remains the technique of choice, these alternatives were found to be effective in preventing bronchial artery back bleeding and avoiding side effects of HCA, such as metabolic changes induced by hypothermia and postoperative neurological complications [ 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review of the Most Updated Literature

Faccioli

Verzeletti

Marra

et al. 2022

JCM

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Pulmonary endarterectomy (PEA) is the treatment of choice in case of chronic thromboembolic pulmonary hypertension (CTEPH). PEA is performed by an increasing number of surgeons; however, the reported outcomes are limited to a few registries or to individual centers’ experiences. This systematic review focuses on pre-operative evaluation, intra-operative procedure and post-operative results in patients submitted to PEA for CTEPH. The literature included was searched using a formal strategy, combining the terms “pulmonary endarterectomy” AND “chronic pulmonary hypertension” and focusing on studies published in the last 5 years (2017–2022) to give a comprehensive overview on the most updated literature. The selection of the adequate surgical candidate is a crucial point, and the decision should always be performed by expert multidisciplinary teams composed of surgeons, pulmonologists and radiologists. In all the included studies, the surgical procedure was performed through a median sternotomy with intermittent deep hypothermic circulatory arrest under cardiopulmonary bypass. In case of residual pulmonary hypertension, alternative combined treatments should be considered (balloon angioplasty and/or medical therapy until lung transplantation in highly selected cases). Short- and long-term outcomes, although not homogenous across the different studies, are acceptable in highly experienced CTEPH centers.

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Section: Introductionmentioning

confidence: 99%

Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review of the Most Updated Literature

Faccioli

Verzeletti

Marra

et al. 2022

JCM

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Predictors of the development of cognitive impairment in patients undergoing pulmonary thromboendarterectomy

Клинкова

Kamenskaya

Логинова

et al. 2023

SJCEM

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Aim: To study the clinical and functional features, as well as intra- and postoperative indicators of patients with chronic thromboembolic pulmonary hypertension (CTEPH) with the development of negative dynamics of cognitive status in the early postoperative period and to identify pathophysiological factors associated with this disorder.Material and Methods. The study included patients with CTEPH scheduled for pulmonary endarterectomy (PEA). The 1st group (38 people) consisted of patients with the development of negative dynamics of cognitive functions according to the MMSE scale in the early postoperative period, the 2nd group (91 people) – without negative dynamics of cognitive functions. Preoperative clinical, anamnestic data, intraoperative parameters, early postoperative complications and their relationship with the negative postoperative dynamics of cognitive status were analyzed.Results. The average age of patients in the general group was 54.1 (44.3–68.1) years. The 1st group was characterized by older age (p = 0.03), a prevalence of patients with diabetes mellitus (p = 0.02), arterial hypertension (p = 0.04), atherosclerosis of the brachiocephalic arteries ≤ 50% (p = 0.04) and higher level of Charlesson comorbidity index (p = 0.002) in comparison with the 2nd group. Intraoperative factors for the development of postoperative cognitive impairment were a longer circulatory arrest (CA) during PEA and a more pronounced decrease in cerebral oxygenation during CA. The 1st group of patients were characterized by a large number of complications, including pulmonary heart failure (p = 0.02), acute renal failure (p < 0.001) and atrial fibrillation (p < 0.001) in comparison with the 2nd group. The development of negative postoperative dynamics of cognitive status in CTEPH patients was associated with baseline reduced cognitive function – OR 2.3 (1.4–9.2 95% CI) (p = 0.01) and with the presence of three or more CA during PEA – OR 3.2 (1.1–12.7 95% CI) (p = 0.01).Conclusion. Independent factors for the development of negative postoperative dynamics of cognitive status in patients with CTEPH were baseline impairment of cognitive function (< 20 points according to the MMSE scale), three or more CA during PEA, and the development of new-onset atrial fibrillation in the early postoperative period.

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Pulmonary Thromboendarterectomy Without Circulatory Arrest

Cited by 2 publications

References 14 publications

Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review of the Most Updated Literature

Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review of the Most Updated Literature

Predictors of the development of cognitive impairment in patients undergoing pulmonary thromboendarterectomy

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