Survival after pulmonary thromboendarterectomy: Effect of residual pulmonary hypertension

Freed, Darren H.; Thomson, Bruce; Berman, Marius; Tsui, Steven; Dunning, John; Sheares, Karen; Pepke‐Zaba, Joanna; Jenkins, David P.

doi:10.1016/j.jtcvs.2009.12.056

Cited by 227 publications

(183 citation statements)

References 24 publications

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“…However, when only residual PH cases were analyzed, 6MWD and symptoms improved until 3 months after PEA, with no further improvement afterward 24. Many studies have shown that residual PH affects prognosis.…”

Section: Discussionmentioning

confidence: 90%

“…In this study, 12 of 39 PEA survivors (30.8%) had residual PH (mPAP ≥25 mm Hg) several weeks after PEA, which is a frequency similar to previous reports. Residual symptom (WHO‐Fc II or higher) is more frequently reported as 69.8% and 62.1% at 3 and 12 months, respectively, after PEA 24. Age, preoperative PVR, New York Heart Association class, right atrial pressure, and female sex were reportedly identified as risk factors for residual PH.…”

Section: Discussionmentioning

confidence: 96%

“…Residual symptoms after PEA remain an issue to be solved, although previous studies have shown better prognosis for patients who achieved mPAP levels <30 mm Hg by PEA 24. We performed additional BPA on 10 patients who had residual symptom after PEA.…”

Section: Discussionmentioning

confidence: 99%

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Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Yanaka

Nakayama

Shinke

et al. 2018

JAHA

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BackgroundResidual symptoms after pulmonary endarterectomy (PEA) remain as the clinical issues to be solved. Additional balloon pulmonary angioplasty (BPA) after PEA showed its efficacy with symptoms in a case series, although long‐term spontaneous recovery of exercise ability after PEA was also reported. However, no studies have validated the clinical efficacy of additional BPA by directly comparing PEA with and without BPA. The aim of this study was to retrospectively evaluate the efficacy of additional BPA as a sequential hybrid therapy for chronic thromboembolic pulmonary hypertension after PEA.Methods and ResultsAmong 44 patients with chronic thromboembolic pulmonary hypertension, 20 patients had residual symptoms after PEA. Of those, 10 patients underwent additional BPA (hybrid group) and were compared with the other 10 patients, who were followed up without BPA (PEA group). The period from PEA to additional BPA was 7.3±2.3 months. In hybrid group, mean pulmonary arterial pressure was significantly improved by PEA (40.6±1.8 to 26.9±3.1 mm Hg, P=0.001) and improved further (to 16.7±1.8 mm Hg, P=0.002) with additional BPA, which resulted in remarkable improvement in World Health Organization (WHO) functional class (pre‐ to post‐BPA: class I/II/III/IV, 0/5/4/1 to 7/3/0/0; P<0.001). Compared with the PEA group at follow‐up, the hybrid group achieved better mean pulmonary arterial pressure (18.7±1.7 versus 30.2±3.2 mm Hg, P=0.008), WHO functional class (class I/II/III/IV, 7/3/0/0 versus 0/8/2/0; P=0.001), and 6‐minute walking distance (429±38 versus 319±22 m, P=0.028).ConclusionsA sequential hybrid strategy improved residual symptoms and exercise capacity compared with single‐PEA therapy.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 96%

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Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Yanaka

Nakayama

Shinke

et al. 2018

JAHA

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“…[25] In our opinion, reducing the mPAP below 30 mmHg is essential. [7,8,12] Pulmonary angiography can play a crucial role in optimal patient selection along with confirming the diagnosis and classification of the type of disease. [16] Close follow-up of cases who survived the APE episode with regard to their persistence of PHT is also necessary.…”

Section: Discussionmentioning

confidence: 99%

“…[11] Post-PTEA PHT not only remains a critical and consistent determinant of perioperative risk but also predicts long-term survival. [12,13] The type of disease is another predictor of outcome. For example, when type 3 and 4 disease is compared with type 1 and 2, a longer need for inotropic support and length of hospital stay is required and higher levels of mPAP and pulmonary vascular resistance occur.…”

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confidence: 99%

Pulmonary embolectomy and thromboendarterectomy in seven cases

Hazan¹,

Şişli²,

Uğurlu³

et al. 2012

Turk Gogus Kalp Dama

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Amaç: Bu çalışmanın amacı, akut pulmoner emboli (APE) ve kronik tromboembolik pulmoner hipertansiyon (KTPHT) olgularının cerrahi ile belirgin olarak düzeldiklerini öngören kanıta dayalı veriler temelinde cerrahi sonrası seyir ile ilgili belirsizliği azaltmak ve bu olgularda cerrahi tedavi seçeneklerini dikkate alan doktorları cesaretlendirmektir. Ça lış ma pla nı: Bu gözlemsel ve geriye dönük gerçekleştirilen çalışmaya Şubat 2009 ile Ekim 2010 tarihleri arasında, APE ve KTPHT tanısı ile ameliyat edilen yedi olgu (3 erkek, 4 kadın; ort yaş 43.8±18.5 yıl; dağılım 25-73 yıl) dahil edildi. Hastaların ameliyat öncesi ve sonrası ortalama pulmoner arter basıncı (mPAP), New York Heart Association (NYHA) fonksiyonel sınıfı, yoğun bakım ünitesi (YBÜ) ve hastanede kalış süresi, demografik, klinik ve ameliyat özellikleri kaydedildi. Olgu sayısının yetersizliğinden dolayı istatistiksel analizler, parametrik olmayan testler ile yapıldı. Grupların karşılaştırılmasında Wilcoxon testi kullanıldı. Bul gu lar: Cerrahi sonrasında bütün hastalarda mPAP'da 20 mmHg (dağılım 5-53) düşüş sağlandı ve altıncı olgu hariç tüm olguların mPAP'ları, 30 mmHg'nın altına çekildi. Ameliyat öncesi ve sonrası mPAP'ları, sırasıyla 43 mmHg (dağılım 33-68) ve 23 mmHg (dağı-lım 15-37) idi. Bu durumda cerrahi sonrasında anlamlı bir düşüş elde edildi (z=-2.36; p=0.018). Buna ilaveten, cerrahi sonrasında hastanın NYHA sınıfındaki iyileşmesi 1 (dağılım 1-3) birimdi. Hastaların ameliyat öncesi ve sonrası NYHA sınıfları sırasıyla III (II-III) ve II (I-II) idi. Ameliyat sonrası NYHA sınıfındaki düşüş ile birlikte cerrahinin iyileştirme üzerine etkisi anlamlıydı (z=-2.26; p= 0.024). Yoğun bakım ünitesi ve hastanede ortalama kalış süreleri, sırasıyla üç (dağılım 2-14) ve 9.5 (dağılım 5-27) gündü. So nuç: Çalışma bulgularımıza göre, ayrıntılı bir ameliyat öncesi değerlendirme ve uygun hasta seçimi ile hekimler, cerrahi seçe-neğin kararında çekimser olmamalı ve hastaların yaşam kalitesini artırmak için çaba harcamalıdır.Anah tar söz cük ler: Akut pulmoner emboli; kronik tromboembolik pulmoner hipertansiyon; fonksiyonel kapasite; ortalama pulmoner arter basıncı; pulmoner tromboendarterektomi.Background:This study aims to reduce the uncertainity related to the prognosis after surgery of the acute pulmonary embolism (APE) and chronic thromboembolic pulmonary hypertension (CTPHT) patients, and to encourage physicians to consider surgical treatment options based on the evidence-based data which suggests that surgery offers the best chance for improvement in these patients. Methods: Between February 2009 and October 2010, seven cases (3 males, 4 females; mean age 43.8±18.5 years; range 25 to 73 years) who were operated on due to APE and CTPHT were included in this observational and retrospective study. The preand postoperative mean pulmonary artery pressure (mPAP), New York Heart Association (NYHA) functional class, and length of stay in the intensive care unit (ICU) and hospital along with the demographic, clinical and operational characteristics of the patients were r...

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Chronic Thromboembolic Pulmonary Hypertension

Papamatheakis

Auger

2017

Handbook of Venous Thromboembolism

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The pulmonary hypertension (PH) and right heart dysfunction that results from chronic thromboembolic involvement of the pulmonary vascular bed is potentially curable with surgical endarterectomy. Over the past several decades, growing clinical experience has brought about increased recognition of this treatable form of PH. Moreover, advances in cardiothoracic surgical techniques have given an increasing number of patients with chronic thromboembolic PH (CTEPH) a surgical remedy with decreasing perioperative morbidity and mortality risks. The availability of pulmonary hypertensive-specific medical therapy for CTEPH patients with surgically inaccessible disease also has been a positive therapeutic advance over the past several years. However, despite this progress, chronic thromboembolic disease as a sequela of acute pulmonary emboli continues to be underappreciated. Furthermore, even if CTEPH has been appropriately diagnosed, misinterpretation of diagnostic information may lead to the inappropriate exclusion of patients from surgical consideration. This may result in the prescription of pulmonary hypertensive medical therapy in CTEPH patients with potentially surgically correctable disease. This difficulty arises from a lack of objective criteria as to what constitutes surgical chronic thromboembolic disease, which primarily is a result of the variability in surgical experience in specialty centers in the United States. Consequently, clinicians must be wary about using pulmonary hypertensive medications in CTEPH patients. Before prescription, it is important to exclude patients from surgical consideration by consulting a specialized center with expertise in this discipline.

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Survival after pulmonary thromboendarterectomy: Effect of residual pulmonary hypertension

Cited by 227 publications

References 24 publications

Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Pulmonary embolectomy and thromboendarterectomy in seven cases

Chronic Thromboembolic Pulmonary Hypertension

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