Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension

Puis, Luc; Vandezande, E; Vercaemst, Leen; Janssens, Patrick; Yvan, Taverniers; Foulon, Mark; Demeyere, Roland; Delcroix, Marion; Daenen, Willem

doi:10.1191/0267659105pf791oa

Cited by 19 publications

(13 citation statements)

References 30 publications

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“…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%

“…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.…”

Section: Quality Of Evidencementioning

confidence: 99%

“…49) Criteria to consider PTE in CTEPH patients was explicitly stated in a few papers only. 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.…”

Section: Quality 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%

“…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.…”

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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