Distal vessel pulmonary thromboendarterectomy: Results from a single institution

Fernandes, Timothy; Kim, Nick H.; Kerr, Kim M.; Auger, William; Fedullo, Peter F.; Poch, David; Yang, Jenny; Papamatheakis, Demosthenes G.; Alotaibi, Mona; Bautista, M. Angela; Pretorius, Victor; Madani, Michael M.

doi:10.1016/j.healun.2023.02.1500

Cited by 9 publications

(6 citation statements)

References 26 publications

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“…10,11 The incidence may be decreasing in more recent series but still affects about 10% of patients. 12 Preoperative hemodynamics, especially RAP and PVR, appear to increase the risk for reperfusion pulmonary edema 13 and for postoperative airway hemorrhage. 14 Airway hemorrhage is also increased in those with preoperative hemoptysis.…”

Section: Discussionmentioning

confidence: 99%

NT‐pro‐BNP is predictive of morbidity and mortality after pulmonary thromboendarterectomy and is independent of preoperative hemodynamics

Keiler,

Kerr,

Poch

et al. 2024

Pulm. circ.

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Current predictors of clinical outcomes after pulmonary thromboendarterectomy (PTE) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) are largely limited to preoperative clinical characteristics. N‐terminal‐pro‐brain natriuretic peptide (NT‐pro‐BNP), a biomarker of right ventricular dysfunction, has not yet been well described as one such predictor. From 2017 to 2021, 816 patients with CTEPH referred to the University of California, San Diego for PTE were reviewed for differences in NT‐pro‐BNP to predict preoperative characteristics and postoperative outcomes up to 30 days post‐PTE. For analysis, NT‐pro‐BNP was dichotomized to less than/equal to or greater than 1000 pg/mL based on the mean of the study population. Mean NT‐pro‐BNP was 1095.9 ±1783.4 pg/mL and median was 402.5 pg/mL (interquartile range: 119.5–1410.8). Of the 816 patients included, 250 had NT‐pro‐BNP > 1000 pg/mL. Those with NT‐pro‐BNP > 1000 pg/mL were significantly more likely to have worse preoperative functional class (III–IV) and worse preoperative hemodynamics. Patients with NT‐pro‐BNP > 1000 pg/mL also tended to have more postoperative complications including reperfusion pulmonary edema (22% vs. 5.1%, p < 0.001), airway hemorrhage (8.4% vs. 4.9%, p = 0.075), residual pulmonary hypertension (11.9% vs. 3.1%, p < 0.001), and 30‐day mortality (4.8% vs. 1.1%, p = 0.001). Even after adjusting for confounders, patients with NT‐pro‐BNP > 1000 pg/mL had a 2.48 times higher odds (95% confidence interval: 1.45–4.00) of reaching a combined endpoint that included the above complications. Preoperative NT‐pro‐BNP > 1000 pg/mL is a strong predictor of more severe preoperative hemodynamics and identifies patients at higher risk for postoperative complications.

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Section: Discussionmentioning

confidence: 99%

NT‐pro‐BNP is predictive of morbidity and mortality after pulmonary thromboendarterectomy and is independent of preoperative hemodynamics

Keiler,

Kerr,

Poch

et al. 2024

Pulm. circ.

Self Cite

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“…One or more PTE surgeons are essential to the CTEPH team. They should be able to perform a complete endarterectomy all the way down to the subsegmental level, and to perform endarterectomy in cases wherein the disease starts in the segmental and subsegmental arteries only [7 ▪ ,8].…”

Section: The Multidisciplinary Chronic Thromboembolic Pulmonary Hyper...mentioning

confidence: 99%

Lessons learned in developing a chronic thromboembolic pulmonary hypertension program

Bair

Heresi

2023

Current Opinion in Pulmonary Medicine

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Purpose of review Chronic thromboembolic pulmonary hypertension (CTEPH) is a deadly underdiagnosed form of pulmonary hypertension, traditionally treated with surgical extraction of thrombo-fibrotic lesions via pulmonary thrombendarterectomy (PTE) surgery. More recently, treatment options have expanded to pulmonary vasodilator medical therapy and balloon pulmonary angioplasty (BPA). This has led to increased awareness and detection of CTEPH, as well as growing interest in performing PTE and BPA. This review will describe the steps required to build a successful CTEPH team in the context of the rapidly evolving treatment of CTEPH. Recent findings CTEPH care requires a multidisciplinary team, including a Pulmonologist or Cardiologist expert in Pulmonary Hypertension, a PTE surgeon, a BPA interventionalist, a dedicated radiologist, cardiothoracic anesthesia and Vascular Medicine or Hematology. Careful assessment of precise imaging and hemodynamic data is needed for operability assessment in the context of the experience of the CTEPH team and surgeon. Medical therapy and BPA are indicated for inoperable CTEPH and residual CTEPH after PTE. Increasingly, multimodality approaches, including surgery, BPA and medical therapy are utilized for best outcomes. Summary An expert CTEPH center requires a multidisciplinary team with dedicated specialists, and time to develop the experience and expertise to achieve high volumes and good outcomes.

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“…The choice of BPA versus PEA can become more complex when patients have subsegmental disease that may be anatomically suitable for both procedures. Recent surgical reports from leading CTEPH centres have demonstrated the efficacy of surgery for patients with subsegmental disease [ 60 ]. A surgical classification was described by the University of California, San Diego, to improve the description of disease within the pulmonary vasculature.…”

Section: Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hype...mentioning

confidence: 99%

ERS International Congress 2023: highlights from the Pulmonary Vascular Diseases Assembly

Cullivan,

Boucly,

Jevnikar

et al. 2023

ERJ Open Res

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Pulmonary vascular diseases such as pulmonary embolism and pulmonary hypertension are important and frequently under recognized conditions. This article provides an overview of key highlights in pulmonary vascular diseases from the 2023 ERS congress. This includes insights into disease modification in pulmonary arterial hypertension and novel therapies such as sotatercept, and seralutinib. Exciting developments in our understanding of the mechanisms underpinning pulmonary hypertension associated with interstitial lung disease are also explored. A comprehensive overview of the complex relationship between acute pulmonary embolism and chronic thromboembolic pulmonary hypertension (CTEPH) is provided and our current understanding of the molecular determinants of CTEPH. The importance of multidisciplinary and holistic care cannot be understated, and this article also addresses advances beyond medication, with a special focus on exercise training and rehabilitation.

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Distal vessel pulmonary thromboendarterectomy: Results from a single institution

Cited by 9 publications

References 26 publications

NT‐pro‐BNP is predictive of morbidity and mortality after pulmonary thromboendarterectomy and is independent of preoperative hemodynamics

NT‐pro‐BNP is predictive of morbidity and mortality after pulmonary thromboendarterectomy and is independent of preoperative hemodynamics

Lessons learned in developing a chronic thromboembolic pulmonary hypertension program

ERS International Congress 2023: highlights from the Pulmonary Vascular Diseases Assembly

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