Japanese Single-Center Experience of Surgery for Chronic Thromboembolic Pulmonary Hypertension

Ogino, Hitoshi; Ando, Motomi; Matsuda, Hitoshi; Minatoya, Kenji; Sasaki, Hiroaki; Nakanishi, Norifumi; Kyotani, Shingo; Imanaka, Hideaki; Kitamura, Soichiro

doi:10.1016/j.athoracsur.2006.03.121

Cited by 112 publications

(88 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ogino et al also reported decreased mortality (8.0%) in CTEPH in Japan. 32 However, the mortality rate of 21.4% for patients with relatively peripheral type is high. In agreement with us, Hoeper et al have also reported that a pre-operative PVR value of >900 dyn·s -1 ·cm -5 is a risk factor for surgery.…”

Section: Discussionmentioning

confidence: 99%

Survival and Quality of Life for Patients With Peripheral Type Chronic Thromboembolic Pulmonary Hypertension

Yoshimi

Tanabe

Masuda

et al. 2008

Circ J

View full text Add to dashboard Cite

hronic thromboembolic pulmonary hypertension (CTEPH) is a relatively rare disease. Its natural history and etiology remain unclear. [1][2][3][4][5] There have been a number of reports that pulmonary thromboendarterectomy (PTE) is an effective modality for treatment in selected patients with CTEPH. [1][2][3][6][7][8][9][10][11] However, the hemodynamic benefit varies according to the location and extent of the thromboembolic occlusion, and Bergin and colleagues reported that the computed tomography (CT) angiographic extent of central disease (ie, CD score) is related to a low pulmonary vascular resistance (PVR) after surgery. 12 Our preliminary data also showed high operative mortality with CD scores of 0 (25%) and 1 (20%), compared with those with a CD score of ≥2 (7.7%), so we classified those patients with a CD score of ≤1 as having relatively peripheral type CTEPH. The cause of operative death was related to residual pulmonary hypertension as a result of failure to remove a distal obstruction. New guidelines have recommended a post-surgical estimated reduction in PVR of >50%. 10 The validity of PTE might be limited to central-type patients, especially in institutions in which the operation is performed infrequently.The prognosis of CTEPH in the medically treated group had been thought to be poor, 13-15 but Ono et al reported that oral beraprost sodium improved their survival. 16 Recently, there have been some reports about improved 6-min walk distance and pulmonary hemodynamics after epoprostenol, 17,18 sildenafil 19 and bosentan [20][21][22] in patients with CTEPH. These new drugs might improve vascular remodeling, and may offer improved survival in patients with relatively peripheral type CTEPH, in whom we predicted a poor reduction in PVR after surgery. We retrospectively tested the validity of PTE from the aspects of survival and quality of life (QOL) at long-term follow up in patients with relatively peripheral type CTEPH. Methods PatientsBetween April 1999 and March 2006, a total of 83 patients admitted consecutively to Chiba University Hospital were diagnosed as having CTEPH and evaluated for surgical indication. CTEPH was defined as having a mean pulmonary arterial pressure (PPA) of ≥25 mmHg with normal wedge pressure in patients who had dyspnea on exertion during a period of more than 6 months. In addition, lung

show abstract

Section: Discussionmentioning

confidence: 99%

Survival and Quality of Life for Patients With Peripheral Type Chronic Thromboembolic Pulmonary Hypertension

Yoshimi

Tanabe

Masuda

et al. 2008

Circ J

View full text Add to dashboard Cite

show abstract

“…Residual pulmonary hypertension (PH) after PEA occurs in ≈10% to 35% of patients4, 8, 17, 18, 19 and is the issue to be solved. It can cause persistent symptoms.…”

mentioning

confidence: 99%

Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Yanaka

Nakayama

Shinke

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundResidual symptoms after pulmonary endarterectomy (PEA) remain as the clinical issues to be solved. Additional balloon pulmonary angioplasty (BPA) after PEA showed its efficacy with symptoms in a case series, although long‐term spontaneous recovery of exercise ability after PEA was also reported. However, no studies have validated the clinical efficacy of additional BPA by directly comparing PEA with and without BPA. The aim of this study was to retrospectively evaluate the efficacy of additional BPA as a sequential hybrid therapy for chronic thromboembolic pulmonary hypertension after PEA.Methods and ResultsAmong 44 patients with chronic thromboembolic pulmonary hypertension, 20 patients had residual symptoms after PEA. Of those, 10 patients underwent additional BPA (hybrid group) and were compared with the other 10 patients, who were followed up without BPA (PEA group). The period from PEA to additional BPA was 7.3±2.3 months. In hybrid group, mean pulmonary arterial pressure was significantly improved by PEA (40.6±1.8 to 26.9±3.1 mm Hg, P=0.001) and improved further (to 16.7±1.8 mm Hg, P=0.002) with additional BPA, which resulted in remarkable improvement in World Health Organization (WHO) functional class (pre‐ to post‐BPA: class I/II/III/IV, 0/5/4/1 to 7/3/0/0; P<0.001). Compared with the PEA group at follow‐up, the hybrid group achieved better mean pulmonary arterial pressure (18.7±1.7 versus 30.2±3.2 mm Hg, P=0.008), WHO functional class (class I/II/III/IV, 7/3/0/0 versus 0/8/2/0; P=0.001), and 6‐minute walking distance (429±38 versus 319±22 m, P=0.028).ConclusionsA sequential hybrid strategy improved residual symptoms and exercise capacity compared with single‐PEA therapy.

show abstract

“…Only the most recent publications with the most complete data set from each institute were retained. As a result, 19 studies 6,15,21,22,25,26,29,30,33,35,36,38,40,[42][43][44][46][47][48] with a total number of 2729 patients were included for appraisal and data extraction ( Table 2).…”

Section: Quantity Of Evidencementioning

confidence: 99%

Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension : A Systematic Review

Rahnavardi

Yan

Cao

et al. 2011

ATCS

View full text Add to dashboard Cite

Purpose: Pulmonary thromboendarterectomy (PTE) is a treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). The present systematic review was performed to assess the safety and efficacy of PTE for CTEPH. Methods: A systematic review was performed, and six electronic databases were searched for published studies from January 1999 to February 2010. All articles that presented morbidity and mortality data, survival data or preoperative and postoperative pulmonary hemodynamic indices were included. The primary outcome measures extracted were early morbidity and mortality, pulmonary hemodynamic and functional outcome indices prior to and after the operation, and survival data. Results: Of the 654 publications retrieved, 19 relevant papers (total number of 2729 patients) representing the most recent and complete data set from each institute, were included for appraisal and data extraction. No randomized controlled trials or matched comparative studies were identified. Thirty-day mortality ranged from 1.3% to 24% (median 8%). Residual pulmonary hypertension was reported in 11%-35% of patients after PTE. Pulmonary artery pressure and pulmonary vascular resistance significantly decreased after PTE in all studies. Before PTE, 60%-100% of patients were in NYHA functional class III or IV. This percentage decreased to 0%-21% after PTE. Five-year survival ranged from 74% to 89%. Conclusions: The current literature suggests that PTE for patients with CTEPH is associated with acceptable perioperative morbidity and mortality rates and improved hemodynamic indices and survival when viewed against the prognosis associated with historical controls using medical therapy.

show abstract

Japanese Single-Center Experience of Surgery for Chronic Thromboembolic Pulmonary Hypertension

Cited by 112 publications

References 15 publications

Survival and Quality of Life for Patients With Peripheral Type Chronic Thromboembolic Pulmonary Hypertension

Survival and Quality of Life for Patients With Peripheral Type Chronic Thromboembolic Pulmonary Hypertension

Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension : A Systematic Review

Contact Info

Product

Resources

About