Residual pulmonary hypertension after pulmonary endarterectomy: A meta-analysis

Hsieh, Wan Chin; Jansa, Pavel; Huang, Wei; Niznansky, Matus; Omara, Mohamend; Lindner, Jaroslav

doi:10.1016/j.jtcvs.2018.04.110

Cited by 68 publications

(74 citation statements)

References 58 publications

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“…124 Although most patients have significant hemodynamic and functional improvement over time, RPH with a PVR over 450 dyn/s/cm and PAPm over 38 mmHg is associated with increased mortality. 36,125,126 The decision on long-term medical management should be based on clinical symptoms and hemodynamics obtained from right heart catheterization 3 to 6 months after PEA. 36,125 Asymptomatic patients with normal or mildly elevated mean PAP can be followed carefully.…”

Section: Rphmentioning

confidence: 99%

Critical Care of Patients After Pulmonary Thromboendarterectomy

Kratzert

Boyd

Saggar

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Rphmentioning

confidence: 99%

Critical Care of Patients After Pulmonary Thromboendarterectomy

Kratzert

Boyd

Saggar

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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“…Of these patients a proportion are able to undergo curative surgery-pulmonary endarterectomy (PEA). A recent meta-analysis reported 25% of individuals may be left with residual pulmonary hypertension (29). These patients are usually treated with standard anti-pulmonary hypertensive medications such as riociguat (only drug approved in CTEPH), phosphodiesterase (PDE) inhibitors, endothelial receptor antagonists and prostanoids.…”

Section: Non-pharmacological Therapies For Phmentioning

confidence: 99%

Key topics in pulmonary vascular diseases (assembly 13) from the European Respiratory Society 2018 Parisian Congress

2018

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“…Метаанализ, проведенный W. Hsieh и соавт., был посвящен остаточной ЛГ после легочной эндартерэктомии у пациентов с ХТЭЛГ. Было доказано, что легочная эндартерэктомия обладает потенциалом для снижения ДЛА и сосудистого сопротивления даже у пациентов с дистальным типом поражения [13]. Наше исследование подтвердило этот факт, во всех группах отмечается значимое улучшение гемодинамических параметров.…”

Section: Discussionunclassified

Results of pulmonary thromboendarterectomy depending on different levels of pulmonary vascular resistance and angiographic index of the pulmonary artery lesion

et al. 2020

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Objective. Pulmonary endarterectomy is a first-choice treatment for patients with chronic thromboembolic pulmonary hypertension. Data describing the results of the operation with different levels of pulmonary vascular resistance (PVR) depending on the spread and percentage of pulmonary artery disease are not declared in the world literature. The aim of our study is to evaluate and compare the hospital results of the operation in patients with different levels of pulmonary vascular resistance, depending on the CT-angiographic index of the pulmonary artery lesion. Materials and methods. A retro-prospective study was conducted, which included 52 patients. All patients were divided into 2 groups, depending on the levels of pulmonary vascular resistance (PVR): group 1 included 31 patients with PVR1000 dynes/cm5, group 2 21 patients with PVR1000 dynes/cm5. Data of the preoperative right heart catheterization in groups 1 and 2, respectively: mean pulmonary artery pressure (mPAP) 44.48.3 and 56.99.6 mm Hg, pulmonary artery wedge pressure 7.32.4 and 61.5 mm. Hg, cardiac output (CO) 3.90.9 and 3.20.6 l/min, cardiac index (CI) 20.5 and 1.60.4 l/min/m2, PVR 767174 and 1272.6186.4 dynsec/cm5. The operation was carried out bilaterally according to a standard protocol with cardiopulmonary bypass, deep hypothermia and circulatory arrest. Results. Data of the right heart catheterization on the first day after the operation in first and second groups, respectively: mPAP 28.56.3 and 35.784.2 mm Hg, PVR 253.3985.5 and 333.9101.9 dynes/cm5, CO 5.370.9 and 5, 21.1 l/min, CI 2.690.39 and 2.60.4 l/min/m2. There was a significant decrease of pulmonary hypertension (p0.05) in the early postoperative period, in both groups. However, a detailed analysis of the obtained data revealed that in patients with pulmonary vascular resistance of more than 1000 dynes/cm5 with a pulmonary artery lesion index of less than 50%, a significant course of the early postoperative period along the combined endpoint was observed. The intensive care unit stay was 4 days in average in both groups. The need for a tracheostomy for the prolongation of artificial ventilation of the lungs was in 2 and 1 cases in first and second groups, respectively. In the first group, there were 5 cases of transient neurological disorders, which regressed at the time of discharge. Two patients in the second group died. Conclusion. Despite the varying levels of baseline PVR, a significant improvement in hemodynamic parameters is observed in the early postoperative period, although patients in group 2 were less proven to normalization of pulmonary hemodynamics. However, a detailed comparative analysis revealed that the most severe category of patients are patients with PVR1000 dynes/cm5, with pulmonary artery lesion index of less than 50%. Thus, the calculation of the CT-angiographic index of pulmonary artery diseases an additional diagnostic method to rate the risks of surgery, especially in patients with a high level of preoperative pulmonary hypertension

show abstract

Residual pulmonary hypertension after pulmonary endarterectomy: A meta-analysis

Cited by 68 publications

References 58 publications

Critical Care of Patients After Pulmonary Thromboendarterectomy

Critical Care of Patients After Pulmonary Thromboendarterectomy

Key topics in pulmonary vascular diseases (assembly 13) from the European Respiratory Society 2018 Parisian Congress

Results of pulmonary thromboendarterectomy depending on different levels of pulmonary vascular resistance and angiographic index of the pulmonary artery lesion

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