Critical Care of Patients After Pulmonary Thromboendarterectomy

Kratzert, Wolf B.; Boyd, Eva K.; Saggar, Rajan; Channick, Richard N.

doi:10.1053/j.jvca.2019.03.005

Cited by 10 publications

(11 citation statements)

References 151 publications

(172 reference statements)

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“…Neurological injury is one of the most common perioperative complications of PTE which is associated with cerebral ischemia resulting from DHCA. 9 Under deep hypothermic (20°C) conditions, a single circulatory arrest time of 20 min or less is generally considered safe and widely used by most centers. [10][11][12] However, in clinical practice, a subset of patients experienced a rapid and sharp decrease of cerebral oxygen saturation (rSO 2 ) when circulatory arrest started, which was also encountered several times in our center.…”

Section: Introductionmentioning

confidence: 99%

“…The circulatory arrest can provide surgeons with a bloodless operative field to allow for precise dissection and maximum clearance of obstructive material. Neurological injury is one of the most common perioperative complications of PTE which is associated with cerebral ischemia resulting from DHCA 9 . Under deep hypothermic (20°C) conditions, a single circulatory arrest time of 20 min or less is generally considered safe and widely used by most centers 10–12 .…”

Section: Introductionmentioning

confidence: 99%

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Duration of regional cerebral oxygen saturation under 40% is a risk factor for neurological injury following pulmonary thromboendarterectomy: A prospective observational study

Liu

Lin

et al. 2022

Journal of Cardiac Surgery

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Background: Deep hypothermic circulatory arrest (DHCA) is nowadays commonly used in pulmonary thromboendarterectomy (PTE). Neurological injury related to DHCA severely impairs the prognosis of patients. However, the risk factors and predictors of neurological injury are still unclear. Methods:We conducted a prospective observational study, including 82 patients diagnosed as chronic thromboembolic pulmonary hypertension and underwent PTE alone in our center from December 2016 to May 2021. Demographic characteristics, clinical and surgical data, and neurological adverse events were recorded prospectively. Univariate and multivariate analyses were conducted to identify the predictors of neurological injury.Results: Eleven (13.4%) patients exhibited neurological injuries after surgery.Univariate analysis showed that the duration of regional cerebral oxygen saturation (rSO 2 ) under 40% (p < .001), the minimum rSO 2 (p = .006), and the percentage of decrease in rSO 2 (p = .011) were significantly associated with neurological injury.Multivariate analysis showed that the duration of rSO 2 under 40% was an independent predictor for postoperative neurological injury (odds ratio = 3.896, 95% confidence interval: 1.812-8.377, p < .001). The receiver operating characteristic curve showed that when the cut-off value was 1.25 min, its sensitivity for predicting neurological injury was 63.6% with a specificity of 88.7%. Conclusions:The duration of rSO 2 under 40% is an independent predictor for neurological injury following PTE. For complicated lesions, more times of circulatory arrest were much safer and more reliable than a prolonged time of a single circulatory arrest. The circulation should be restored as soon as possible, when the rSO 2 under 40% is detected, rather than waiting for 5 min.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Duration of regional cerebral oxygen saturation under 40% is a risk factor for neurological injury following pulmonary thromboendarterectomy: A prospective observational study

Liu

Lin

et al. 2022

Journal of Cardiac Surgery

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“…However, the treatment strategy for CTEPH patients with severe carotid stenosis is not clear. Neurological injury is one of the most common perioperative complications of PTE and is associated with cerebral ischemia resulting from DHCA ( 10 ). The presence of severe carotid artery stenosis could dramatically increase the risk of perioperative neurological injury.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Successful Concomitant Pulmonary Thromboendarterectomy and Carotid Endarterectomy

Liu

Zheng

et al. 2022

Front. Cardiovasc. Med.

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Pulmonary thromboendarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension. Pulmonary thromboendarterectomy concomitant with additional cardiac procedures was reported as safe and feasible. However, the treatment strategy for chronic thromboembolic pulmonary hypertension patients with severe carotid stenosis is still not clear. We describe a case of successful concomitant pulmonary thromboendarterectomy and carotid endarterectomy.

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“…In addition, anesthetic care, perioperative mechanical ventilation strategies, anticoagulation management, and adequate hemodynamic monitoring are of vital importance, as are anesthesiologists and intensivists trained in performing this type of surgery and in providing extracorporeal membrane oxygenation (ECMO), if necessary. 57 Despite the extent of the surgical procedure, the European registry shows that operated patients have significantly greater survival than non-operated patients, underscoring the role of PTEA as the first-line treatment for eligible patients. 50 On the basis of intraoperative findings, patients are classified into resection categories, which are associated with surgical benefit and long-term prognosis ( Chart 4 ).…”

Section: Treatment Of Ctephmentioning

confidence: 99%

Brazilian Thoracic Society recommendations for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension

Fernandes¹,

Ota-Arakaki²,

Campos³

et al. 2020

J Bras Pneumol.

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious and debilitating disease caused by occlusion of the pulmonary arterial bed by hematic emboli and by the resulting fibrous material. Such occlusion increases vascular resistance and, consequently, the pressure in the region of the pulmonary artery, which is the definition of pulmonary hypertension. The increased load imposed on the right ventricle leads to its progressive dysfunction and, finally, to death. However, CTEPH has a highly significant feature that distinguishes it from other forms of pulmonary hypertension: the fact that it can be cured through treatment with pulmonary thromboendarterectomy. Therefore, the primary objective of the management of CTEPH should be the assessment of patient fitness for surgery at a referral center, given that not all patients are good candidates. For the patients who are not good candidates for pulmonary thromboendarterectomy, the viable therapeutic alternatives include pulmonary artery angioplasty and pharmacological treatment. In these recommendations, the pathophysiological bases for the onset of CTEPH, such as acute pulmonary embolism and the clinical condition of the patient, will be discussed, as will the diagnostic algorithm to be followed and the therapeutic alternatives currently available.

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Critical Care of Patients After Pulmonary Thromboendarterectomy

Cited by 10 publications

References 151 publications

Duration of regional cerebral oxygen saturation under 40% is a risk factor for neurological injury following pulmonary thromboendarterectomy: A prospective observational study

Duration of regional cerebral oxygen saturation under 40% is a risk factor for neurological injury following pulmonary thromboendarterectomy: A prospective observational study

Case Report: Successful Concomitant Pulmonary Thromboendarterectomy and Carotid Endarterectomy

Brazilian Thoracic Society recommendations for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension

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