International survey on the perioperative management of pulmonary endarterectomy: the perfusion perspective

Stanzel, Roger; Gehron, Johannes; Wolff, Matthias; Striegl, Natalie; Roth, P.; Boedeker, Rolf-Hasso; Scheibelhut, Christine; Herrmann, Jens; Welters, Ingeborg; Mayer, Eckhard; Scheffler, Matthias

doi:10.1177/0267659117724865

Cited by 3 publications

(2 citation statements)

References 30 publications

(32 reference statements)

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“…Minimal inotropic support with catecholamines such as dopamine, noradrenaline, or vasopressin is enough to maintain hemodynamic stability. 105 However, complications such as reperfusion injury, residual PH, hypoxemia, hemoptysis, and RV dysfunction should be anticipated. 106…”

Section: Separation From Cardiopulmonary Bypass: Pulmonary Endarterec...mentioning

confidence: 99%

Perioperative Management in Pulmonary Endarterectomy

Jenkins

Martínez

Salaunkey

et al. 2023

Semin Respir Crit Care Med

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Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (PH), provided lesions are proximal enough in the pulmonary vasculature to be surgically accessible and the patient is well enough to benefit from the operation in the longer term. It is a major cardiothoracic operation, requiring specialized techniques and instruments developed over several decades to access and dissect out the intra-arterial fibrotic material. While in-hospital operative mortality is low (<5%), particularly in high-volume centers, careful perioperative management in the operating theater and intensive care is mandatory to balance ventricular performance, fluid balance, ventilation, and coagulation to avoid or treat complications. Reperfusion pulmonary edema, airway hemorrhage, and right ventricular failure are the most problematic complications, often requiring the use of extracorporeal membrane oxygenation to bridge to recovery. Successful PEA has been shown to improve both morbidity and mortality in large registries, with survival >70% at 10 years. For patients not suitable for PEA or with residual PH after PEA, balloon pulmonary angioplasty and/or PH medical therapy may prove beneficial. Here, we describe the indications for PEA, specific surgical and perioperative strategies, postoperative monitoring and management, and approaches for managing residual PH in the long term.

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Section: Separation From Cardiopulmonary Bypass: Pulmonary Endarterec...mentioning

confidence: 99%

Perioperative Management in Pulmonary Endarterectomy

Jenkins

Martínez

Salaunkey

et al. 2023

Semin Respir Crit Care Med

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“…4 Due to the complexity of PEA and DHCA-related complications, expert perfusion practice is essential for favorable outcomes, especially cerebral protection strategies. A recent international survey 5 demonstrated great variance among different centers regarding perfusion practice, including blood pump, circuit coating, prime solution, and target hematocrit (Hct). The current guidelines of CTEPH management or PEA surgery did not contain recommendations on perfusion practice which was important and might have an impact on patients' outcome, 6,7 raising a question whether there is future potential for consensus on optimal perfusion strategy.…”

Section: Introductionmentioning

confidence: 99%

Perfusion strategy and mid-term results of 58 consecutive pulmonary endarterectomy

et al. 2019

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Objective: The aim of this retrospective study was to review and report short-term and mid-term outcomes of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension at our institute in the recent 2 years and to describe perfusion strategy. Methods: A total of 58 consecutive patients with chronic thromboembolic pulmonary hypertension underwent pulmonary endarterectomy under deep hypothermia circulatory arrest with an established perfusion practice between November 2015 and December 2017. Peri-operative data and patients’ outcome were retrospectively analyzed. Results: Mean pulmonary artery pressure was decreased (49 (40-56) mmHg vs 27 (20-31) mmHg, p < 0.001), and pulmonary vascular resistance (724 (538-1108) vs 206 (141-284) dyn second cm−5, p < 0.001) improved significantly after surgery. In-hospital mortality was 1.7% and postoperative complication rate was 27.6%. Antipsychotic medication of olanzapine was prescribed for 36 patients (62.1%), which was independently related to total deep hypothermic circulatory arrest time, postoperative blood potassium concentration, and hematocrit. The majority of patients recovered uneventfully with good mid-term cardiac function (New York Heart Association I-II: 98.1%) and neurological outcome (Glasgow Outcome Scale—Extended Upper Good Recovery: 74.1% and Lower Good Recovery: 20.3%). Mid-term neurological outcome was associated with post–pulmonary endarterectomy antipsychotic medication. Conclusion: Short-term and mid-term outcome after pulmonary endarterectomy was comparable to high-volume centers. Incidence of post–pulmonary endarterectomy delirium was relatively high and associated with mid-term neurological outcome. Total deep hypothermic circulatory arrest time, postoperative blood potassium concentration, and hematocrit were independent risk factors of postoperative olanzapine medication. More efforts and further research are required to optimize the neuroprotection of perfusion practice.

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