Long-Term Outcome after Pulmonary Thromboendarterectomy

Abstract

This study evaluated long-term outcome of pulmonary thromboendarterectomy (PTE) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Survival, functional status, quality of life, health care utilization, and relationships between these parameters and postoperative pulmonary hemodynamics were assessed. Questionnaires were mailed to 420 patients who were more than 1 yr post-PTE; 308 responded (mean age, 56 yr [range, 19-89 yr]; mean years since PTE, 3.3 [range, 1- 16]). Survival after PTE was 75% at > 6 yr. After surgery, symptoms were markedly reduced. Median distance walked was 5,280 ft; 56 patients could walk "indefinitely." Of the working population, 62% of patients unemployed before PTE returned to work. Post-PTE patients scored several quality of life components of the Rand SF-36 slightly lower than reported normals but significantly higher than did pre-PTE patients. Ten percent of patients used oxygen. Ninety-three percent were in NYHA Class I or II. Disease-related hospitalizations/ER visits were minimal. A relationship was shown between 48 h postoperative pulmonary vascular resistance (PVR) and walking and stair-climbing ability, NYHA class, dyspnea scores, and the physical function and general health quality of life components. These data indicate that PTE offers most CTEPH patients substantial improvement in survival, function, and quality of life, with minimal disease-related health care utilization.

Survival and Quality of Life for Patients With Peripheral Type Chronic Thromboembolic Pulmonary Hypertension

“…These results are similar to those of Archibald and colleagues, 29 whose study showed that postoperative patients had significantly better SF-36 scores (except for mental health) compared with those of pre-operative patients. In addition, for those with relatively peripheral type, 6 of 11 survivors after the survey did not need oxygen therapy, but all medically treated patients needed to con- tinue oxygen therapy.…”

“…The 6-year survival rate for the surgically treated group was 78.6% for relatively peripheral type and 92.3% for central type, values which are close to that obtained by Archibald et al's study (ie, 75% 6-year survival rate). 29 However, medical treatment offered better survival for patients with relatively peripheral type and with a mean PPA of >30 mmHg when compared with previous reports. [13][14][15] Several issues need to be considered when interpreting the results.…”

ASPIRE registry: Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre

“…In PAH, a pulmonary arteriopathy leads to progressively increasing pulmonary vascular resistance (PVR), resulting in right heart failure and early death. The emergence of targeted drug therapies for PAH since the late 1990s and pulmonary endarterectomy (PEA) as a definitive treatment for CTEPH revolutionised the previously limited options for patients [2][3][4]. Due to the rarity of these diseases, expense of therapies and required expertise, seven specialist PH centres that adhere to nationally agreed standards of care [5,6] were first designated in the UK in 2001.…”

Die Ballon-Okklusionsangiographie der Pulmonalarterien bei chronischer pulmonaler Hypertonie

“…Dann wird das thrombembolische Material in die Gefäßwand eingebaut mit der Folge einer bleibenden Reduktion des Gesamtquerschnittes der Pulmonalisstrombahn. Beginnen diese thrombembolischen Veränderungen der Gefäßwand auf Höhe der Segmentarterien oder proximal davon, steht mit der pulmonalen Thrombendarteriektomie ein chirurgisches Verfahren zur Verfügung, das eine wirksame kausale Behandlung der Erkrankung mit guten Langzeitergebnissen erlaubt (Mayer et al, 1996;Moser et al, 1987;Archibald et al, 1999 (Frazier et al, 2000).…”

“…Die chirurgische pulmonale Thrombendarteriektomie (PTEA) ist eine effiziente Behandlungsoption, die bei ausgewählten Patienten mit Erfolg durchgeführt werden kann (Mayer et al, 1996;Moser et al, 1987;Archibald et al, 1999). Die…”