Mid-term results of surgery for chronic thromboembolic pulmonary hypertension

• Published in: Interactive cardiovascular and thoracic surgery Vol. 9; no. 4; pp. 626 - 629
• Main Authors: Ishida, Keiichi, Masuda, Masahisa, Tanaka, Hideo, Imamaki, Mizuho, Katsumata, Masayoshi, Maruyama, Takuto, Miyazaki, Masaru
• Format: Journal Article
• Language: English
• Published: England Eur Assoc Cardio Surg 01-10-2009
• Subjects: Adult; Aged; Blood Pressure; Endarterectomy - adverse effects; Endarterectomy - mortality; Female; Hemodynamics; Humans; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - mortality; Hypertension, Pulmonary - physiopathology; Hypertension, Pulmonary - surgery; Hypoxia - etiology; Hypoxia - physiopathology; Hypoxia - surgery; In Vitro Techniques; Middle Aged; Oxygen Inhalation Therapy; Pulmonary Artery - physiopathology; Pulmonary Artery - surgery; Recovery of Function; Recurrence; Severity of Illness Index; Thromboembolism - complications; Thromboembolism - mortality; Thromboembolism - physiopathology; Thromboembolism - surgery; Time Factors; Treatment Outcome; Vascular Resistance; Young Adult
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2009.210492

a Division of Cardiovascular Surgery, Department of General Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1 Chuo-ku, Chiba 260-0856, Japan
b Department of Cardiovascular Surgery, National Hospital Organization, Chiba Medical Center, Tsubakimori 4-1-2 Chuo-ku, Chiba 260-8606, Japan
*Corresponding author. Tel.: [phone]; fax: [phone]. E-mail address : keiichi-ishida{at}pro.odn.ne.jp (K. Ishida).
Pulmonary thromboendarterectomy is an effective surgical treatment for chronic thromboembolic pulmonary hypertension (CTEPH). In this study, we review our short- and mid-term results in the recent series of patients undergoing pulmonary thromboendarterectomy. Twenty-three patients (54±12 years) were re-evaluated 7–59 months (mean, 34 months) after surgery. Nine patients were in New York Heart Association functional class II, 11 patients in class III and three patients in class IV. All patients used supplemental oxygen therapy. After surgery, pulmonary hemodynamics were significantly improved: pulmonary vascular resistance (PVR) decreased from 925±342 to 337±260 dynes·s·cm –5 ( P <0.01); mean pulmonary artery pressure (MPAP) decreased from 47±12 to 25±10 mmHg ( P <0.01). Three patients developed severe residual pulmonary hypertension and one of them died soon after surgery. During the follow-up period there were no deaths, but one recurrence of pulmonary embolism. Nineteen patients (86%) were in New York Heart Association functional class I or II and thirteen patients (59%) were weaned from oxygen therapy. In conclusion, pulmonary thromboendarterectomy provided remarkable early and late results with acceptable hospital mortality rate, normalization of pulmonary hemodynamics, and improvement in clinical functional status with relief of hypoxemia.
Key Words: Chronic thromboembolic pulmonary hypertension; Pulmonary hypertension; Pulmonary thromboendarterectomy; Surgical outcomes