Mid-term results of surgery for chronic thromboembolic pulmonary hypertension

Abstract

Pulmonary thromboendarterectomy is an effective surgical treatment for chronic thromboembolic pulmonary hypertension (CTEPH). In this study, we review our short- and mid-term results in the recent series of patients undergoing pulmonary thromboendarterectomy. Twenty-three patients (54+/-12 years) were re-evaluated 7-59 months (mean, 34 months) after surgery. Nine patients were in New York Heart Association functional class II, 11 patients in class III and three patients in class IV. All patients used supplemental oxygen therapy. After surgery, pulmonary hemodynamics were significantly improved: pulmonary vascular resistance (PVR) decreased from 925+/-342 to 337+/-260 dynes x s x cm(-5) (P<0.01); mean pulmonary artery pressure (MPAP) decreased from 47+/-12 to 25+/-10 mmHg (P<0.01). Three patients developed severe residual pulmonary hypertension and one of them died soon after surgery. During the follow-up period there were no deaths, but one recurrence of pulmonary embolism. Nineteen patients (86%) were in New York Heart Association functional class I or II and thirteen patients (59%) were weaned from oxygen therapy. In conclusion, pulmonary thromboendarterectomy provided remarkable early and late results with acceptable hospital mortality rate, normalization of pulmonary hemodynamics, and improvement in clinical functional status with relief of hypoxemia.

Pulmonary embolectomy and thromboendarterectomy in seven cases

“…Our significant results regarding the decrease in the mPAP (p=0.018) resemble those found in the literature. [10,17,25,26] Moreover, our significant improvement in the NYHA functional class (p=0.024) is also parallel with the results of Saouti et al, [10] Narayana Iyengar et al [25] and Ishida et al [26] The inadequate number of cases in our retrospective study is a drawback; therefore, larger case series are needed for further investigation.…”

Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension : A Systematic Review

“…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).…”

“…Four prospective studies were identified, 30,38,40,46) ; other studies were either clearly retrospective 6,15,22,25,29,35,42,44,47,48) or not specified. 21,26,33,43) Two studies presented results in a series of CTEPH patients treated surgically and medically 40,47) ; others included only series of surgically treated patients. There was one retrospective study from Austria that compared hemodynamic indices between PTE and non-PTE patients with a 1-year follow-up, but could not be included in the current review due to insufficient data to meet the inclusion criteria.…”

“…25,29,33,42) With the exception of one multicenter study from the UK 40) and another study from Germany including two centers, 36) other studies were from single tertiary referral centers. 6,15,21,22,25,26,29,30,33,35,38,[42][43][44][46][47][48] The largest series included 988 patients who underwent isolated PTE from 1997 to 2007 at UCSD. 6) Seven series had more than 100 patients, 6,15,25,38,40,44,47) five had between 50 and 100 patients (range 50-88), 22,29,30,35,43) and the other seven series had less than 50 patients each (range 23-41).…”

“…6) Seven series had more than 100 patients, 6,15,25,38,40,44,47) five had between 50 and 100 patients (range 50-88), 22,29,30,35,43) and the other seven series had less than 50 patients each (range 23-41). 21,26,33,36,42,46,48) The surgical technique was clearly described in one study, 6) and some modifications to Jamieson's technique were described in two studies. 21,36) T h i r t y-d ay m o r t a l it y wa s r e p o r t e d by a l l studies.…”