Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ten years experience in Denmark

Mellemkjær, Søren; Ilkjær, Lars Bo; Klaaborg, Kaj Erik; Christiansen, C. L.; Severinsen, Inge Krogh; Nielsen‐Kudsk, Jens Erik; Allermand, H; Egeblad, M; Kristensen, Bent Bruun

doi:10.1080/14017430500338513

Cited by 38 publications

(32 citation statements)

References 12 publications

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“…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.…”

Section: Quality Of Evidencementioning

confidence: 99%

“…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%

“…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).…”

Section: Quality Of Evidencementioning

confidence: 99%

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Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension : A Systematic Review

Rahnavardi

Yan

Cao

et al. 2011

ATCS

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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.

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Section: Quality Of Evidencementioning

confidence: 99%

Section: Quantity Of Evidencementioning

confidence: 99%

Section: Quality Of Evidencementioning

confidence: 99%

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Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension : A Systematic Review

Rahnavardi

Yan

Cao

et al. 2011

ATCS

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“…In-hospital mortality rates for patients who have undergone PEA range from 5% to 24% [5,10,11], and in general, periprocedural mortality rates of 5-11% are achieved [1,9,12]. However, not all patients are eligible for surgery because of an inaccessible and/or distal thromboembolism, or serious comorbidities [13,14].…”

mentioning

confidence: 99%

“…However, not all patients are eligible for surgery because of an inaccessible and/or distal thromboembolism, or serious comorbidities [13,14]. Moreover, PH can persist or reappear in patients who have undergone PEA, and persistent PH is one of the most important determinants of post-PEA outcome [11,15,16]. Furthermore, high mean pulmonary arterial pressure (Ppa) is an independent predictor of death in patients with ''chronic PE'' (p50.04) [17].…”

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confidence: 99%

Managing chronic thromboembolic pulmonary hypertension: pharmacological treatment options

Lang¹

2009

European Respiratory Review

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening condition in which organised thrombi obstruct the pulmonary vessels, causing increased pulmonary vascular resistance, progressive pulmonary hypertension (PH) and right heart failure. The treatment of choice is pulmonary endarterectomy, which restores pulmonary haemodynamics with acceptable periprocedural mortality rates in the majority of suitable patients. However, CTEPH may be inoperable owing to surgically inaccessible thrombi or comorbid diseases that confer an unacceptably high risk.Pharmacotherapies, although not yet approved, may be useful in this situation or for treating residual or recurrent PH following surgery. Vasodilator drugs for PH are attracting growing interest as potential treatments for CTEPH because this disease has recently been labelled as a ''dual'' pulmonary vascular disorder: major vessel obstruction and remodelling is combined with a small vessel arteriopathy that is histologically indistinguishable from the classical pulmonary arteriopathy observed in pulmonary arterial hypertension.Of three completed randomised controlled trials in patients with CTEPH, only one was powered to detect a treatment effect. The BENEFIT trial employed the dual endothelin-receptor antagonist bosentan. Although haemodynamics improved significantly, the second component of the primary end-point, exercise capacity, was not met.More evidence is required to resolve whether vasodilator treatments are beneficial for inoperable chronic thromboembolic pulmonary hypertension.

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Association of residual pulmonary hypertension with survival after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension

et al. 2022

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This study investigated whether residual pulmonary hypertension (PH), defined as early postoperative mean pulmonary artery pressure (mPAP) of ≥30 mmHg, after undergoing pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) was associated with longterm survival. All patients who underwent PEA for CTEPH at two Scandinavian centers were included in this study. Baseline characteristics and vital statuses were obtained from patient charts and national health-data registers. The patients were then categorized based on residual PH measured via right heart catheterization within 48 h after undergoing PEA. Crude and weighted flexible parametric survival models were used to estimate the association between residual PH and all-cause mortality and to quantify absolute survival differences. From 1992 to 2020, 444 patients underwent surgery. We excluded 6 patients who died on the day of surgery and 12 patients whose early postoperative pulmonary hemodynamic data was unavailable. Of the total study population (n = 426), 174 (41%) and 252 (59%) patients had an early postoperative mPAP <30 and ≥30 mmHg, respectively. After weighting, there was a significant association between residual PH and all-cause mortality (hazard ratio: 2.49; 95% confidence interval [CI]: 1.60-3.87), and the absolute survival difference between the groups at 10 and 20 years was -22% (95% CI: -32% to -12%) and-32% (95% CI: -47% to -18%), respectively. A strong and clinically relevant association of residual PH with long-term survival after PEA for CTEPH was found. After accounting for differences in baseline characteristics, the absolute survival difference at long-term follow-up was clinically meaningful and imply careful surveillance to improve clinical outcomes in these patients. Early postoperative right heart catheter

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Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ten years experience in Denmark

Cited by 38 publications

References 12 publications

Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension : A Systematic Review

Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension : A Systematic Review

Managing chronic thromboembolic pulmonary hypertension: pharmacological treatment options

Association of residual pulmonary hypertension with survival after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension

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