Long-term Outcomes After Pulmonary Endarterectomy in 499 Patients Over a 20-Year Period

Miyahara, Shunsuke; Schröder, Tom Alexander; Wilkens, Heinrike; Karliova, Irem; Langer, Frank; Kunihara, Takashi; Schäfers, Hans‐Joachim

doi:10.1016/j.athoracsur.2020.06.122

Cited by 15 publications

(34 citation statements)

References 23 publications

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“…The survival outcomes for operated patient subgroups in this study are in agreement with a long-term outcomes study, which found that freedom from CTEPH-related death (defined as cardiac death, respiratory failure, hemorrhagic stroke, and death from an unknown cause) at 10 years post-PEA was lower in patients with normal mean pulmonary arterial pressure (89.0%) compared with those with residual PH (67.9%). 48 These outcome data should be interpreted in the historical context of the study: the usage of BPA and medical therapies in the Czech Republic was confined to the very end of this study's observation period. This allows for the observation of the natural history of CTEPH and the impact of PEA alone on survival, thus providing a point of reference against which future studies can measure the impact of new treatment options.…”

Section: Discussionmentioning

confidence: 98%

“…The survival outcomes for operated patient subgroups in this study are in agreement with a long‐term outcomes study, which found that freedom from CTEPH‐related death (defined as cardiac death, respiratory failure, hemorrhagic stroke, and death from an unknown cause) at 10 years post‐PEA was lower in patients with normal mean pulmonary arterial pressure (89.0%) compared with those with residual PH (67.9%). 48 …”

Section: Discussionmentioning

confidence: 99%

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Epidemiology of chronic thromboembolic pulmonary hypertension (CTEPH) in the Czech Republic

Jansa

Ambrož

Kuhn³

et al. 2022

Pulm. circ.

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This study investigated the epidemiology and survival outcomes of chronic thromboembolic pulmonary hypertension (CTEPH) in the Czech Republic, wherein pulmonary endarterectomy (PEA) surgery was the only targeted treatment option until 2015. This study included all consecutive adults newly diagnosed with CTEPH in the Czech Republic between 2003 and 2016. Incidence/prevalence rates were calculated using general population data extracted from the Institute of Health Information and Statistics of the Czech Republic. Kaplan–Meier estimates of survival from diagnosis until 2018 were calculated. Of a total of 453 patients observed, 236 (52.1%) underwent PEA (median time from diagnosis to PEA: 2.9 months) and 71 (34.1%) had residual pulmonary hypertension (PH) post‐PEA. CTEPH incidence rate (95% confidence interval [CI]) between 2006 and 2016 was 4.47 (4.05; 4.91) patients per million (ppm) per year, and the prevalence (95% CI) was 37.43 (33.46; 41.73) ppm in 2016. The rate of CTEPH‐related hospitalizations (95% CI) per 100 person‐years was 24.4 (22.1; 26.9) for operated patients and 34.2 (30.9; 37.7) for not‐operated patients. Median overall survival (95% CI) for all patients from CTEPH diagnosis was 11.2 (9.4; not reached) years. Five‐year survival probability (95% CI) was 95.3% (89.9; 97.9) for operated patients without residual PH, 86.3% (75.3; 92.7) for operated patients with residual PH and 61.2% (54.0; 67.6) for not‐operated patients. This study reported epidemiological estimates of CTEPH in the Czech Republic consistent with estimates from other national systematic registries; and indicates an unmet medical need in not‐operated patients and operated patients with residual PH.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Epidemiology of chronic thromboembolic pulmonary hypertension (CTEPH) in the Czech Republic

Jansa

Ambrož

Kuhn³

et al. 2022

Pulm. circ.

View full text Add to dashboard Cite

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“…Previous research has indicated conflicting results regarding the relationship between early postoperative pulmonary hemodynamics and long‐term survival. 1 , 7 , 14 , 15 , 16 , 17 , 18 Direct comparisons of studies are difficult owing to the criteria for persistent or residual post‐PEA PH varying across different studies, and also because measurements were obtained at various times after surgery (e.g., postoperative days 1–3, or 3–6 months postoperatively). Previous literature used different criteria to define persistent or residual PH, and some used definitions based on mPAP, 1 , 7 , 15 , 17 while others used PVR, 16 , 18 or a combination of both.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 10 Previous research has indicated conflicting results regarding the relationship between early postoperative pulmonary hemodynamics and long‐term survival. 1 , 7 , 14 , 15 , 16 , 17 , 18 Interpretation of prior studies is complicated because differing criteria to define persistent or residual PH have been used. Moreover, the timing and modality for acquiring hemodynamic measurements varied among studies.…”

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confidence: 99%

Association of residual pulmonary hypertension with survival after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension

et al. 2022

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This study investigated whether residual pulmonary hypertension (PH), defined as early postoperative mean pulmonary artery pressure (mPAP) of ≥30 mmHg, after undergoing pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) was associated with longterm survival. All patients who underwent PEA for CTEPH at two Scandinavian centers were included in this study. Baseline characteristics and vital statuses were obtained from patient charts and national health-data registers. The patients were then categorized based on residual PH measured via right heart catheterization within 48 h after undergoing PEA. Crude and weighted flexible parametric survival models were used to estimate the association between residual PH and all-cause mortality and to quantify absolute survival differences. From 1992 to 2020, 444 patients underwent surgery. We excluded 6 patients who died on the day of surgery and 12 patients whose early postoperative pulmonary hemodynamic data was unavailable. Of the total study population (n = 426), 174 (41%) and 252 (59%) patients had an early postoperative mPAP <30 and ≥30 mmHg, respectively. After weighting, there was a significant association between residual PH and all-cause mortality (hazard ratio: 2.49; 95% confidence interval [CI]: 1.60-3.87), and the absolute survival difference between the groups at 10 and 20 years was -22% (95% CI: -32% to -12%) and-32% (95% CI: -47% to -18%), respectively. A strong and clinically relevant association of residual PH with long-term survival after PEA for CTEPH was found. After accounting for differences in baseline characteristics, the absolute survival difference at long-term follow-up was clinically meaningful and imply careful surveillance to improve clinical outcomes in these patients. Early postoperative right heart catheter

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“…First of all, PEA has an in-hospital mortality that is, in high-volume centers, less than 5% (1,6,7). Secondly, 10% to 50% of patients (according to the different definitions utilized) may have persistent PH after surgery (3) and this can impact long-term outcomes, reducing exercise capacity (8) and, in some clinical records, survival as well (5,6,8). The severity of persistent PH that seems to be prognostically relevant is still debated.…”

mentioning

confidence: 99%