Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension

Ishida, Keiichi; Masuda, Masahisa; Tanabe, Nobuhiro; Matsumiya, Goro; Tatsumi, Koichiro; Nakajima, Nobuyuki

doi:10.1016/j.jtcvs.2011.09.004

Cited by 64 publications

(48 citation statements)

References 22 publications

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“…Taking into account that PEA is a surgery with considerable risk, patients that most likely benefit from the surgery in the long term have to be selected carefully. Persistence or recurrence of PH is regarded as main prognostic factor for long-term survival [11] or functional capacity [12] . Several mechanisms such as incomplete removal of obstructions and irreversible small-vessel arteriopathy Values represent mean ± SD unless otherwise indicated.…”

Section: Discussionmentioning

confidence: 99%

“…However, predicting those patients with favorable long-term results remains challenging. Residual pulmonary hypertension (PH) after surgery has been identified as the main determinant for longterm outcome in terms of survival [11] or functional capacity [12] . Preoperative predictors of early postoperative outcome in terms of decreased PVR 48 h after PEA are mPAP [13] , serum creatinine level, the number of involved segments, PVR and gender [14] .…”

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confidence: 99%

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Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy

Richter

Sommer²,

Gall³

et al. 2015

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put (CO) from 4.4 ± 0.8 to 6.5 ± 1.9 l/min and diastolic pulmonary gradient (DPG) from 14.6 ± 4.9 to 20.7 ± 12.7 mm Hg. Post-PEA mPAP increased from 23.7 ± 6.6 at rest to 43.2 ± 7.1 mm Hg, while CO increased to a higher extent from 5.1 ± 0.9 to 8.4 ± 1.9 l/min. There were significant correlations between pre-PEA DPG/CO and dPAP/CO slopes with the pulmonary vascular resistance (Spearman r = 0.578, p = 0.019, and r = 0.547, p = 0.028) and mPAP at rest after PEA (Spearman r = 0.581, p = 0.018, and r = 0.546, p = 0.028). Conclusions: In CTEPH, the presurgical dynamic DPG/CO and dPAP/ CO slopes during submaximal exercise are associated with the hemodynamic outcome 1 year after PEA.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy

Richter

Sommer²,

Gall³

et al. 2015

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“…The Papworth group has a follow-up programme for all patients after PEA and reported a 5-year survival of 92.5%, conditional from 3-month follow-up, indicating that in patients who survive the peri-operative period, the medium-term outcome is excellent [34]. In a longer-term study of 77 patients, freedom from disease-specific death at 5 and 10 years post-PEA was determined to be 84% and 82%, respectively, although the cohort number was small at later follow-up [35].…”

Section: Effectiveness Of Pea and Survival Ratesmentioning

confidence: 97%

Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension

2015

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Pulmonary endarterectomy (PEA) is the treatment of choice to relieve pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH). It is a complex surgical procedure with a simple principle: removal of obstructive thromboembolic material from the pulmonary arteries in order to reduce pulmonary vascular resistance, relieve pulmonary hypertension (PH) and alleviate right ventricular dysfunction. In the majority of patients there is symptomatic and prognostic benefit. However, not all patients with CTEPH are suitable for treatment with PEA. Operability assessment is not always easy, being largely subjective and based on experience. It is therefore important that all patients are referred to an experienced CTEPH centre for careful evaluation of suitability for surgery. The most common reason for inoperability is distal vasculopathy accounting for a high proportion of the vascular resistance. Surgery requires cardiopulmonary bypass and periods of deep hypothermic circulatory arrest. Complications include reperfusion lung injury and persistent PH. However, with careful patient selection, surgical technique and post-operative management, PEA is a highly effective treatment with mortality rates <5% at experienced centres. Patients who are unsuitable for surgery may be candidates for medical therapy. @ERSpublications A review of pulmonary endarterectomy as a CTEPH treatment, including patient assessment, risks and outcomes http://ow.ly/L82F7

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“…Although CTEPH is ameliorated by pulmonary endarterectomy, patients with high pulmonary vascular resistance and predominant small vessel disease suffer from sig-nificant mortality (5)(6)(7). Hence, more than one-third of CTEPH patients are also treated medically, approximately half of whom are given oral PAH therapies, such as PDE-5 inhibitors and ERA (8).…”

Section: Introductionmentioning

confidence: 99%

Polymorphism of the G Protein β3 Subunit Gene Influences the Efficacy of Sildenafil in Patients with Pulmonary Hypertension

et al. 2014

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Objective The C825T polymorphism in the G protein β3 subunit gene (GNB3) influences the efficacy of sildenafil in patients with erectile dysfunction. The effects of this polymorphism on the therapeutic response to sildenafil in patients with pulmonary hypertension remains unknown. To investigate whether the GNB3 C825T polymorphism is associated with the clinical efficacy of sildenafil in patients with pulmonary hypertension. Methods Fifty-nine patients (age: 55.6±13.3 [SD] yrs., mean pulmonary arterial pressure (Ppa): 52±11 mmHg) with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension were treated with sildenafil. The pre-and post-treatment parameters, including pulmonary hemodynamics measured using right heart catheterization, the systolic pulmonary arterial pressure estimated on Doppler echocardiography (sPA), the six-minute walk distance (6MWD) and freedom from clinical worsening, were compared between the patients with the TT and CT/CC genotypes. Results The pretreatment parameters were not significantly different between the two groups, with the exception of a lower mean Ppa in the TT group. The post-treatment World Health Organization (WHO) class was significantly better (p=0.03) and the 6MWD values trended toward improvement in the TT genotype patients compared with that observed in the CC/CT genotype patients (p=0.05). The time to clinical worsening was significantly longer in the TT genotype patients than in the CC/CT genotype patients (3-year freedom from clinical worsening: 83.1% vs. 46.0%, p=0.02), while the TT genotype was found to be a significant predictor of freedom from clinical worsening, even after adjusting for the baseline mean Ppa. Conclusion The GNB3 C825T polymorphism influences the efficacy of sildenafil in patients with pulmonary hypertension.

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Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension

Abstract: Pulmonary endarterectomy had sustained favorable effects on long-term survival. High pulmonary vascular resistance was associated with in-hospital death, and postoperative mean pulmonary arterial pressure was an independent predictor of adverse events.

Cited by 64 publications

References 22 publications

Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy

Pulmonary Hemodynamic Response to Exercise in Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy

Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension

Polymorphism of the G Protein β3 Subunit Gene Influences the Efficacy of Sildenafil in Patients with Pulmonary Hypertension

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