Pulmonary endarterectomy outputs in chronic thromboembolic pulmonary hypertension

Gude, María Jesús López; Sota, Enrique Pérez de la; Vela, J.L. Pérez; Rodríguez, Jorge Rodríguez; Guijosa, Christian Muñoz; Velázquez, María T.; Chaterina, Sergio Alonso; González, Ignacio Hernández; Subías, Pilar Escribano; Romero, José María

doi:10.1016/j.medcle.2017.06.004

Cited by 5 publications

(9 citation statements)

References 29 publications

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“…In our study population, 68.5% were classified as WHO III-IV functional class at the time of surgery (5.3% as WHO IV), and mPAP was 46.5±13.1 mmHg and mean PVR was 764.5±392.8 dyn•s•cm −5 . Furthermore, PEA surgical times were similar to international specialized centers, including a mean total arrest time of 42.8±14.5 minutes In-hospital stay (days) 14 [9][10][11][12][13][14][15][16][17][18][19][20][21] In-hospital mortality 11 (3. and mean CBP of 215.8±47.0 minutes; despite concomitant surgery being performed in a group of 70 (20.6%) patients. Overall perioperative mortality was 3.3%, similar to the largest series reported in the literature by international specialized centers (8,(17)(18)(19), and below mean European rates (7); placing Spanish CSUR CTEPH Centers in an outstanding international position.…”

Section: Discussionmentioning

confidence: 83%

“…PEA is a technically demanding operation, currently only performed in very few selected centers around the world; optimal results are associated with better patient selection, better perioperative care and greater surgical experience (1,5,8). When performed in specialized centers, better results are found in terms of patient survival, functional class and exercise capacity due to the improvement of hemodynamics after the surgery (4,7,(9)(10)(11). Furthermore, the ability of PEA to allow access to the lesions does not only depend on their anatomical distribution, but also on the surgeon's previous experience (2).…”

Section: Introductionmentioning

confidence: 99%

“…However, all patients should be referred and carefully evaluated by a Multidisciplinary Expert Team, where every individual case is discussed, and the most suitable treatment is chosen. The Multidisciplinary Expert Team is made up of pulmonologists, cardiologists, radiologists and cardiac surgeons specialized in PEA (9). There are two PH specialized centers in Spain that bring together most CTEPH patients (>60%), designated as Centros, Servicios y Unidades de Referencia del Sistema Nacional de Salud (CSUR): Hospital Clínic, Barcelona, and Hospital Universitario 12 de Octubre, Madrid (5,14).…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension: the Spanish experience

López-Gude¹,

Blanco²,

Benito-Arnaiz³

et al. 2022

Ann Cardiothorac Surg

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Background: Chronic thromboembolic pulmonary hypertension (CTEPH) can be cured by pulmonary endarterectomy (PEA). It is considered the best and only curable treatment option for patients with accessible lesions evaluated as optimal candidates. We describe the experience of the two reference centers in Spain, in order to reinforce the need for referring CTEPH patients to a specialized center to be assessed by a Multidisciplinary Expert Team. Methods: We included a population of 338 patients who met the definition for CTEPH and underwent PEA between January 2007 and December 2019. The surgery was indicated in almost 60% of patients assessed. Demographic, anthropometric, hemodynamic and echocardiographic features are listed for PEA patients. Immediate and one-year postoperative outcomes as well as overall mortality were analyzed. Results: Mean age was 53.5±15.0 years, 53.8% were men; a total of 68.5% were in WHO functional class III-IV; and most of them were in a severe preoperative hemodynamic condition: mean pulmonary arterial pressure (mPAP) was 46.5±13.1 mmHg and mean pulmonary vascular resistance (PVR) was 764.5± 392.8 dyn•s•cm −5 . PEA surgery was performed with cardiopulmonary bypass (CBP) and circulatory arrest, with very few complications [including neurological, postoperative reperfusion edema, extracorporeal membrane oxygenation (ECMO) implant and cardiac failure] and optimal postoperative results, where exercise capacity increased and mPAP and PVR values decreased significantly. Presence of persistent pulmonary hypertension (PH) at the six-month right heart catheterization was evaluated. A 3.3% perioperative mortality was achieved. Overall, one-, three-and five-year survival rates were analyzed by Kaplan-Meier's method (94.8%, 93.3% and 90.5% respectively), as well as for residual PH patients. Mortality risk factors were assessed.Conclusions: Outstanding PEA results were seen in the immediate, one-year and long-term outcomes.The incidence of complications, including in-hospital mortality and long-term mortality were also below European rates.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension: the Spanish experience

López-Gude¹,

Blanco²,

Benito-Arnaiz³

et al. 2022

Ann Cardiothorac Surg

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“…8,9 However, there is also data in the literature suggesting that high mortality in high PVR patients may be related to the learning curve of the surgical team. 7 More data are needed to determine whether the risk of patients with high PVR can be reduced by greater surgical experience in patients undergoing endarterectomy with additional cardiac procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Other clinics experienced a similar learning curve in the early period of PEA procedures. 7 This once again points to the need to concentrate these cases in selected centers.…”

Section: Intracardiac Thrombus 4 (7%)mentioning

confidence: 99%

Outcomes of Pulmonary Endarterectomy Operation Concomitant with Cardiac Procedures

Erdem

Korun

Yanartaş

et al. 2020

Thorac Cardiovasc Surg

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Background The aim of this study was to analyze the results of pulmonary endarterectomy (PEA) performed simultaneously with additional cardiac procedures in a single tertiary-level center. Methods Data of patients who underwent PEA with additional cardiac procedures for chronic thromboembolic pulmonary hypertension (CTEPH) in our clinic were retrospectively reviewed using patient records. Results Between March 2011 and April 2019, 56 patients underwent PEA with additional cardiac surgery. The most common additional procedure was coronary artery bypass grafting (21 patients; 38%). The median intensive care unit and hospital stays were 4 (3–6) days and 10 (8–14) days. Mortality was recorded in six patients (11%). In multivariate analysis, only preoperative pulmonary vascular resistance (PVR) (p = 0.02; odds ratio [OR]: 1.003) and cardiopulmonary bypass duration (p = 0.02; OR: 1.028) were associated with mortality. When the cutoff value of 1000 dyn.s.cm−5 was taken in the receiver operating characteristic curve analysis, preoperative PVR predicted mortality with 83% sensitivity and 94% specificity (area under curve = 0.89; p < 0.01). Conclusion PEA for CTEPH may be performed safely with other cardiac operations. This type of surgery is a complex procedure that should be performed only in expert centers. Patients with high preoperative PVR are at increased risk of perioperative complications.

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Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review

Brookes¹,

Li²,

Chung³

et al. 2022

Ann Cardiothorac Surg

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Background: Pulmonary thromboendarterectomy (PTE) is the gold standard treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, the results are poorly quantified outside a few registry reports and several individual centers.Methods: A systematic review was performed searching five electronic databases assessing the outcomes for adult patients undergoing PTE for CTEPH. All articles that reported mortality data were included.Primary outcome measures were early/inpatient mortality; secondary outcomes were survival, pulmonary haemodynamics, morbidity and functional status following PTE for CTEPH. Results were pooled via a meta-analysis of proportions and meta-regression.Results: A total of 5,717 studies were identified, yielding sixty-one relevant papers. Thirty-day mortality ranged from 0.8% to 24.4%, and on meta-analysis was 8.4% [95% confidence interval (CI): 7.2-9.6%].Mortality was noted to decrease with increasing center volume of PTE cases (P<0.01). Residual pulmonary hypertension was reported in 8.2% to 44.5% of patients.Conclusions: CTEPH is associated with acceptable short-term mortality and an improvement in pulmonary hemodynamics. With increasing volume of experience and ongoing developments over time perioperative mortality continues to decrease.

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Pulmonary endarterectomy outputs in chronic thromboembolic pulmonary hypertension

Cited by 5 publications

References 29 publications

Pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension: the Spanish experience

Pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension: the Spanish experience

Outcomes of Pulmonary Endarterectomy Operation Concomitant with Cardiac Procedures

Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review

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