Pulmonary endarterectomy in severe chronic thromboembolic pulmonary hypertension

被引：31
作者：
de Perrot, Marc [1 ]
Thenganatt, John [1 ]
McRae, Karen [1 ]
Moric, Jakov [1 ]
Mercier, Olaf [1 ]
Pierre, Andrew [1 ]
Mak, Susanna [1 ]
Granton, John [1 ]
机构：
[1] Univ Toronto, Toronto Gen Hosp, Toronto Pulm Endarterect Program, Toronto, ON M5G 1L7, Canada
来源：
JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2015年 / 34卷 / 03期
关键词：
thromboembolic pulmonary hypertension; pulmonary endarterectomy; decompensated right heart failure; outcome; total peripheral vascular resistance; ARTERIAL-HYPERTENSION; EMBOLISM; IMPROVEMENT; EXPERIENCE; MANAGEMENT; SURVIVAL;
D O I：
10.1016/j.healun.2014.09.008
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
BACKGROUND: The outcome of patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary endarterectomy (PEA) after urgent hospitalization for decompensated right heart failure (DRFIF) remains unclear. METHODS: Among 120 consecutive patients undergoing PEA, 16 (13%) presented with a history of urgent hospitalization for DRHF (severe RHF group). This group was compared with the remaining 104 patients presenting with total peripheral vascular resistance (TPR) < 1,200 dynes.sec.cm(-5) (n = 78, control group) and >1,200 dynes.sec.cm(-5) (n = 26, high TPR group). RESULTS: DRHF occurred predominantly in patients with TPR > 1,200 dynes.sec.cm(-5) (prevalence of 32% vs 5% in patients with TPR < 1,200 dynes.sec.cm(-5), p < 0.0001). The overall in-hospital mortality after PEA was 4% (n = 5). All deaths occurred in patients with TPR > 1,200 dynes.sec.cm(-5) and DRHF. The proportion of patients with residual PH immediately after surgery was higher in the high TPR group (50%) and severe REF group (56%) compared with the control group (29%; p = 0.04). In multivariate analysis, risk factors for residual PH after surgery were TPR > 1,200 dynes.sec.cm(-5), Jamieson disease Type III-IV, and female gender. A history of DRHF by itself was not a risk factor for residual PH after PEA. The overall 5-year survival was 87%. After a median followup of 20 months, the proportion of patients receiving medical therapy for residual PH was higher in patients with post-operative mean pulmonary artery pressure 35 mm Hg (61% vs 9%, p = 0.0007). CONCLUSIONS: DRHF occurs more frequently in patients with TPR > 1,200 dynes.sec.cm(-5), increasing the operative risk in these patients. The outcome of patients with high TPR in the absence of DRHF is excellent. However, patients with residual mean pulmonary artery pressure >35 mm Hg frequently receive pulmonary hypertension therapy after PEA. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.
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收藏
页码：369 / 375
页数：7
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