Clinical and hemodynamic outcomes and mortality risk factors in patients undergoing pulmonary thromboendarterectomy

Abstract

Background: Pulmonary thromboendarterectomy is the current treatment of choice in patients with chronic thromboembolic pulmonary hypertension. The objective of the present study was to analyze the clinical and hemodynamic outcomes and the risk factors for mortality in a cardiovascular center in Colombia. Methods: Cohort study, conducted between 2001 and 2019. All operated patients were included in the study. Risk factors associated with mortality were established by means of a multivariate regression using the COX method and survival was established using the Kaplan-Meier method. p < 0.05 was considered statistically significant. Results: Seventy-three patients were operated. Median age was 51 years, 55% of females, 79% had functional Class III and IV. The mean pulmonary arterial pressure was 50 mmHg and 640 dyn.s.cm −5 for pulmonary vascular resistance (PVR). After the intervention, there was a decrease in mean pulmonary artery pressure (p ≤ 0.001) and in PVR (p = 0.357); 21% had evidence of residual pulmonary hypertension. Only 8% and 6% continued with functional Class III and IV at 6 and 12 months, respectively. There were 15 deaths (19.1%; 12% at 30 days). The factors associated with mortality were the diastolic diameter of the right ventricle measured postoperatively (hazard ratio [HR] 10.88 95% confidence interval [CI] 1.97-62, p = 0.007), time of invasive mechanical ventilation (HR 1.06 95% CI 1.02-1.09 p = 0.004), and the presence of complications during the surgical procedure . Conclusions: Pulmonary thromboendarterectomy is associated with excellent clinical and hemodynamic outcomes. The mortality risk factors found are not those usually described in the literature.

Peri-Operative Changes of Inflammatory Markers and Their Implications in Pulmonary Endarterectomy

“…Thus, it is expected that ventilator-associated pneumonia would be prevalent in CTEPH patients after PEA [ 78 ]. Furthermore, a longer time of ventilatory support and a longer stay in the intensive care unit would increase the possibility of nosocomial or care-related infections, leading to death [ 80 ]. Procalcitonin (PCT) is a highly specific marker for the diagnosis of clinically relevant bacterial infections and sepsis [ 11 ], and is used as a predictive factor for postoperative complications following cardiac surgery [ 81 , 82 ].…”

Nursing role in the care of patients undergoing pulmonary thromboendarterectomy. An integrative review

“…In addition, mortality in other studies was 10% after one year of follow-up. 9 Furthermore, Figueredo et al 5 evaluated the results of eight patients who had decreased PVR and mean pulmonary pressure, and found that the basal oxygen saturation increased. Survival in a similar study was 100% after 24 months of follow up.…”

Papel de enfermería en el cuidado del paciente sometido a tromboendarterectomía pulmonar. Revisión integrativa

“…Conde et al 8 evaluaron 54 pacientes y encontraron mejoría en la clase funcional y en la caminata de 6 minutos; adicionalmente, la mortalidad en otros estudios fue del 10% en un seguimiento a 1 año 9 . Por su parte, Figueredo et al 5 evaluaron los resultados de 8 pacientes, en quienes se presentó diminución de la RVP y de la presión pulmonar media, y observaron que la saturación de oxígeno basal aumentó; la sobrevida en un estudio similar fue del 100% a los 24 meses de seguimiento 10 .…”