Pulmonary Thromboendarterectomy in 106 Patients With Chronic Thromboembolic Pulmonary Hypertension

Gude, María Jesús López; Sota, Enrique Pérez de la; Gil, Alberto; Rodríguez, Jorge Rodríguez; Eixerés, Andrea; Velázquez, María T.; M, Nistal; Vela, J.L. Pérez; Caño, María José; Sánchez, Miguel; Subías, Pilar Escribano; Romero, José María

doi:10.1016/j.arbr.2015.05.014

Cited by 11 publications

(13 citation statements)

References 35 publications

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“…An important and higher proportion than that reported presented chest pain in our population 8,18 . The time from the onset of symptoms to diagnosis is similar to that reported (12 months), not being the case for the times from diagnosis to surgery (78 days vs. 12 months) and from the onset of symptoms to the surgical procedure (24 months vs. 17 months) 8,15,16 , surely something related to the Colombian health-care system. The stay in the intensive care unit was shorter than that reported (6 vs. 14) with similar days of mechanical ventilation (2 on average) 8,15 .…”

Section: Discussionsupporting

confidence: 75%

“…The majority of the patients had marked symptoms, 79% being in functional Class III and IV (Table 1). The initial echocardiogram 6 [3-13] 20 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] showed right ventricular dilation in 63%, with a median pulmonary artery pressure of 79 mmHg, tricuspid annular plane systolic excursion (TAPSE) of 16, and a quarter of the population had moderate-to-severe tricuspid regurgitation (Table 1 supplementary appendix). The mean pressure of the pulmonary artery was 50 mmHg in the right catheterization, with PVR of 640 dyn.s.cm −5 and systemic resistance of 1600 dyn.s.cm −5 .…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the baseline characteristics of the population, these accord with those of the group of patients published by two of the largest registries in the United States 15 and Europe 8 . The history of thrombophilia is in a medium range in relation to the different series, coinciding with the antiphospholipid syndrome being the A B main alteration 16,17 . Most of the patients (79%) presented severe and limiting symptoms measured in their baseline functional class (III and IV) something that is also similar to those documented in large centers 8,15 .…”

Section: Discussionmentioning

confidence: 99%

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Resultados clínicos y hemodinámicos y factores de riesgo de mortalidad en pacientes sometidos a tromboendarterectomía pulmonar

Ramos

Saldarriaga-Giraldo

Yepes-Calderón

et al. 2021

ACM

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Background: Pulmonary thromboendarterectomy is the current treatment of choice in patients with chronic thromboembolic pulmonary hypertension. The objective of the present study was to analyze the clinical and hemodynamic outcomes and the risk factors for mortality in a cardiovascular center in Colombia. Methods: Cohort study, conducted between 2001 and 2019. All operated patients were included in the study. Risk factors associated with mortality were established by means of a multivariate regression using the COX method and survival was established using the Kaplan-Meier method. p < 0.05 was considered statistically significant. Results: Seventy-three patients were operated. Median age was 51 years, 55% of females, 79% had functional Class III and IV. The mean pulmonary arterial pressure was 50 mmHg and 640 dyn.s.cm −5 for pulmonary vascular resistance (PVR). After the intervention, there was a decrease in mean pulmonary artery pressure (p ≤ 0.001) and in PVR (p = 0.357); 21% had evidence of residual pulmonary hypertension. Only 8% and 6% continued with functional Class III and IV at 6 and 12 months, respectively. There were 15 deaths (19.1%; 12% at 30 days). The factors associated with mortality were the diastolic diameter of the right ventricle measured postoperatively (hazard ratio [HR] 10.88 95% confidence interval [CI] 1.97-62, p = 0.007), time of invasive mechanical ventilation (HR 1.06 95% CI 1.02-1.09 p = 0.004), and the presence of complications during the surgical procedure . Conclusions: Pulmonary thromboendarterectomy is associated with excellent clinical and hemodynamic outcomes. The mortality risk factors found are not those usually described in the literature.

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Section: Discussionsupporting

confidence: 75%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Resultados clínicos y hemodinámicos y factores de riesgo de mortalidad en pacientes sometidos a tromboendarterectomía pulmonar

Ramos

Saldarriaga-Giraldo

Yepes-Calderón

et al. 2021

ACM

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“…[4][5][6] Predictors of in-hospital mortality in the German NIS Regarding predictors of mortality, the UK-PH registry demonstrated in 239 CTEPH patients that a preoperative pulmonary resistance above 1000 dyneÁsÁcm À5 was associated with increased perioperative mortality, whereas higher cardiac index and longer six-minute walk distance were associated with a better perioperative survival. 16 Similarly, an elevated PVR as well as NYHA class IV were identified as a predictor of 30-day mortality in 214 19 and 106 20 CTEPH patients who underwent PEA in previous studies. In the present study, NYHA class III/IV was also associated with increased in-hospital mortality in an univariate, but not in a multivariate logistic regression model.…”

Section: Comparison Of the German Nis With Other Study Cohorts Worldwidementioning

confidence: 73%

Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension

et al. 2021

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Chronic thromboembolic pulmonary hypertension (CTEPH) is considered as a rare but severe complication after acute pulmonary embolism (PE) and is potentially curable by pulmonary endarterectomy (PEA). We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of PEA in CTEPH patients and to investigate predictors of the in-hospital course. We analyzed data on the characteristics, comorbidities, treatments and in-hospital outcomes for all CTEPH patients treated with PEA in the German nationwide inpatient sample between 2006 and 2016. Overall, 1,398 inpatients were included. Annual number of PEA increased from 67 in 2006 to 194 in 2016 (P<0.001), in parallel with a significant decrease of in-hospital mortality (10.9% in 2008 to 1.5% in 2016; P<0.001). Patientsâ characteristics shifted slightly towards older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Independent predictors of in-hospital mortality were age (OR 1.03 [95%CI 1.01-1.05]; P=0.001), right heart failure (2.55 [1.37-4.76]; P=0.003), in-hospital complications such as ischemic stroke (6.87 [1.06-44.70]; P=0.044) and bleeding events like hemopneumothorax (24.93 [6.18-100.57]; P<0.001). Annual PEA volumes per center below 10 annual procedures were associated with higher rates of adverse in-hospital outcomes. Annual numbers of CTEPH patients treated with PEA increased markedly in Germany between 2006 and 2016, in parallel with a decrease of in-hospital mortality. Our findings suggest that perioperative management of PEA, institutional experience and patient-selection are crucial and have improved over time.

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“…The most life-threatening complication of PTE is acute pulmonary hemorrhage, 1 , 2 and incidence is reported as high as 4%. 1 It occurs when endarterectomy plane goes deep enough to perforate the PA, resulting in bleeding into surrounding airways. 2 , 3 At our institution, we have observed 2 such cases in our first 246 PTEs (0.8%).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous coil embolization to manage pulmonary artery hemorrhage after distal endarterectomy

et al. 2020

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Pulmonary Thromboendarterectomy in 106 Patients With Chronic Thromboembolic Pulmonary Hypertension

Cited by 11 publications

References 35 publications

Resultados clínicos y hemodinámicos y factores de riesgo de mortalidad en pacientes sometidos a tromboendarterectomía pulmonar

Resultados clínicos y hemodinámicos y factores de riesgo de mortalidad en pacientes sometidos a tromboendarterectomía pulmonar

Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension

Percutaneous coil embolization to manage pulmonary artery hemorrhage after distal endarterectomy

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