Pulmonary endarterectomy for chronic thrombo-embolic pulmonary hypertension: An institutional experience
European Journal of Cardio-thoracic Surgery, cilt.44, sa.3, 2013 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 44 Sayı: 3
- Basım Tarihi: 2013
- Doi Numarası: 10.1093/ejcts/ezt293
- Dergi Adı: European Journal of Cardio-thoracic Surgery
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Anahtar Kelimeler: Chronic thrombo-embolic pulmonary hypertension, Pulmonary endarterectomy, Mortality, Outcome
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective: Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thrombo-embolic pulmonary hypertension (CTEPH). The aim of this study was to review our initial experience since the implementation of our program. Methods: Data were collected prospectively on all patients who underwent PEA between March 2011 and March 2012. Results: Forty-nine patients (20 male, 29 female, mean age 47.7 years) underwent surgery. The preoperative NewYork Heart Association class distribution showed the majority to be in class III or IV (n = 40). Mortality rate was 14.2% (n = 7) and the morbidity rate was 26.5% (n = 13). After PEA, the durations of mechanical ventilation, intensive care stay and hospital stay before discharge were 49.7 ± 46.1 h, 6.5 ± 5.0 days and 12.9 ± 7.5 days, respectively. The systolic and mean pulmonary artery pressure (PAP) fell significantly from 87.0 ± 26.6 mmHg and 53.8 ± 14.5 before, to 41.5 ± 12.4 mmHg and 28.5 ± 10.5 after surgery (P < 0.001 and P < 0.001, respectively). Pulmonary vascular resistance (PVR) also improved significantly from 808 ± 352.0 to 308 ± 91 dyn•s•cm-5 (P < 0.001). Univariate analysis showed that preoperative systolic PAP, tricuspid annular plane systolic excursion, right atrial volume, right atrial pressure, forced expiratory volume in 1 s, forced vital capacity, preoperative PVR, postoperative PVR, the duration of circulatory arrest and postoperative use of extracorporeal membrane oxygenation were risk factors formortality (P < 0.05). According to multivariate analyses, only prolonged mechanical ventilation was selected as predictive risk factor for morbidity (P = 0.005). After a median follow-up of 6.1 months, two patients died due to cerebrovascular disease and one patient needed targetedpulmonary hypertension therapy. The rest of the 39 patients showed marked improvements in their clinical status. Conclusions: Starting a pulmonary endarterectomy program with acceptable mortality and morbidity rates and satisfactory early-term outcomes increases awareness of the CTEPH and surgery. Preoperative factors can primarily predict postoperative outcome after PEA. Identifying the risk factors in order to achieve a good result is important for the success of a PEA program. Therefore all patients diagnosed with CTEPH should be referred for consideration of PEA in a specialized centre. © The Author 2013. Published by Oxford University Presson behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.