Long-term outcomes after pulmonary endarterectomy

Dardi, Fabio; Manes, Alessandra; Guarino, Daniele; Suàrez, Sofia Martìn; Loforte, Antonio; Rotunno, Mariangela; Pacini, Davide; Galiѐ, Nazzareno; Palazzini, Massimiliano

doi:10.21037/acs-2021-pte-179

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…Additionally, common comorbidities observed included thyroid disease, hypertension, ischemic heart disease and hyperuricemia. These findings, notably consistent with the results reported in other studies [24][25][26][27], highlight the complex interplay of various systemic conditions in the aetiology and clinical course of CTEPH.…”

Section: Discussionsupporting

confidence: 92%

Comorbidities, Treatment and Survival Rates of Chronic Thromboembolic Pulmonary Hypertension in a Regional Centre

Bertici,

Ridichie

et al. 2024

JCM

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Background/Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by a multitude of underlying causes, treatment modalities and prognostic outcomes. Our aim was to evaluate the underlying causes, comorbidities and survival rates of CTEPH patients. Methods: A retrospective analysis was conducted regarding the evolution of CTEPH patients confirmed by right heart catheterization under treatment with specific vasodilator medication in our centre between 2008 and 2023. Results: We treated 14 CTEPH patients, 78.57% female, 52.79 ± 13.64 years at inclusion, representing 11.29% of our pulmonary arterial hypertension registry. Initially, the distribution of patients’ NYHA class was II-14.28%, III-71.42% and IV-14.28%. In total, 71.42% of these patients were technically operable due to the central location of the thrombus, but 42.85% presented severe comorbidities and 28.57% refused the surgery or it was financially inaccessible. Only four patients were operated on by pulmonary endarterectomy (PEA). Unfortunately, all the post-PEA patients had persistent pulmonary hypertension and had to continue vasodilator treatment. Overall, 64.28% of patients had monotherapy, 21.42% double therapy and 14.28% triple therapy. Regarding underlying causes and comorbidities, we found the following incidences: 78.57% chronic venous insufficiency, 42.85% obesity, 35.71% thyroid disease, hypertension and hyperuricemia, 21.42% thrombophilia and ischemic heart disease, 14.28% atrial fibrillation, vasculitis and lung disease, and 14.28% neoplastic history and diabetes. Seven patients died (50%), six of whom were unoperated and one of whom was lost (abandoned the program). The survival rates at 1, 3, 5 and 7 years for unoperated patients were 100%, 58.3%, 29.2% and 29.2% versus 100%, 75%, 75% and 75% in post-PEA patients. Conclusions: CTEPH, marked by delayed diagnosis, multiple comorbidities and limited intervention options, requires proactive screening and comprehensive multimodal therapies, including PEA, to improve survival rates.

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Section: Discussionsupporting

confidence: 92%

Comorbidities, Treatment and Survival Rates of Chronic Thromboembolic Pulmonary Hypertension in a Regional Centre

Bertici,

Ridichie

et al. 2024

JCM

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“…4.2. The impact of PEA and BPA on long-term outcomes in patients with CTEPH According to Dardi et al, 14 CTEPH can be cured by PEA; thus, PEA is recommended as the first-line treatment for patients with CTEPH. Good long-term outcomes and high survival rates in patients with CTEPH receiving PEA have also been reported in previous studies.…”

Section: Epidemiology Hemodynamics and Mortality Of Ctephmentioning

confidence: 99%

The long-term outcome of chronic thromboembolic pulmonary hypertension: Pulmonary endarterectomy and balloon pulmonary angioplasty

Yang,

Wang,

Tao

et al. 2024

Journal of the Chinese Medical Association

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Background: The long-term outcome on patients with chronic thromboembolic pulmonary hypertension (CTEPH) has not been ideal after standard medical treatment. However, good outcome for patients with CTEPH after interventions such as pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) has been reported recently. The aim of this study was to evaluate the impact of PEA or BPA on long-term outcomes for CTEPH patients in Han-Chinese population. Methods: This was a multi-center, prospective case-control study. Patients with CTEPH were enrolled between January, 2018 and March, 2020. They were divided into two groups, including intervention (PEA or BPA) and conservative groups. The followed-up period was 26 months after treatment. The endpoints were all-cause mortality and CTEPH mortality. Results: A total of 129 patients was enrolled and assigned to receive PEA/BPA (N=73), or conservative therapy (N=56). Overall, the 26-month survival rate of all-cause mortality was significantly higher in intervention group compared to that in conservative group (95.89%. vs. 80.36%; log-rank p = 0.0164). The similar trend was observed in the 26-month survival rate of CTEPH mortality (97.26% vs. 85.71%; log-rank p = 0.0355). Regarding cox proportional-hazard regression analysis, the hazard ratios (HR) on patients with CTEPH receiving intervention in the outcome of all-cause mortality and CTEPH mortality were statistically significant [HR = 0.07 and p = 0.0141 in all-cause mortality; HR = 0.11 and p = 0.0461 in CTEPH mortality]. Conclusion: This multi-center prospective case-control study demonstrated that intervention such as PEA and BPA increased the long-term survival rate for patient with CTEPH significantly. Intervention was an independent factor in long-term outcome for patients with CTEPH, including all-cause mortality and CTEPH mortality.

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“…Pulmonary thromboendarterectomy (PTE) is the treatment of choice in eligible patients as it provides excellent symptomatic and prognostic improvement [1]. Within 2-3 weeks of successful surgery, there is rapid reverse RV remodeling with improvement in RV volumes and function [2]. However, surgery is not without risks, and the presence of a dilated RV with low systolic function and pulmonary vascular resistance (PVR) >600 dynes/s/cm 2 are strong predictors of poor prognosis [2].…”

Section: Introductionmentioning

confidence: 99%

“…Within 2-3 weeks of successful surgery, there is rapid reverse RV remodeling with improvement in RV volumes and function [2]. However, surgery is not without risks, and the presence of a dilated RV with low systolic function and pulmonary vascular resistance (PVR) >600 dynes/s/cm 2 are strong predictors of poor prognosis [2]. Despite continuing improvements in the safety and efficacy of PEA, with a perioperative mortality rate of <5% in expert CTEPH centers [3,4], there are specific complications such as residual PH and reperfusion lung injury that increase mortality and morbidity following surgery.…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography Pulmonary Angiography Prediction of Adverse Long-Term Outcomes in Chronic Thromboembolic Pulmonary Hypertension: Correlation with Hemodynamic Measurements Pre- and Post-Pulmonary Endarterectomy

Gopalan,

Riley,

Leong

et al. 2023

Tomography

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CT pulmonary angiography is commonly used in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). This work was conducted to determine if cardiac chamber size on CTPA may also be useful for predicting the outcome of CTEPH treatment. A retrospective analysis of paired CTPA and right heart hemodynamics in 33 consecutive CTEPH cases before and after pulmonary thromboendarterectomy (PTE) was performed. Semiautomated and manual CT biatrial and biventricular size quantifications were correlated with mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and cardiac output. The baseline indexed right atrioventricular volumes were twice the left atrioventricular volumes, with significant (p < 0.001) augmentation of left heart filling following PTE. Except for the left atrial volume to cardiac index, all other chamber ratios significantly correlated with hemodynamics. Left to right ventricular ratio cut point <0.82 has high sensitivity (91% and 97%) and specificity (88% and 85%) for identifying significant elevations of mPAP and PVR, respectively (AUC 0.90 and 0.95), outperforming atrial ratios (sensitivity 78% and 79%, specificity 82% and 92%, and AUC 0.86 and 0.91). Manual LV:RV basal dimension ratio correlates strongly with semiautomated volume ratio (r 0.77, 95% CI 0.64–0.85) and is an expeditious alternative with comparable prognostic utility (AUC 0.90 and 0.95). LV:RV dimension ratio of <1.03 and ≤0.99 (alternatively expressed as RV:LV ratio of >0.97 and ≥1.01) is a simple metric that can be used for CTEPH outcome prediction.

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Long-term outcomes after pulmonary endarterectomy

Cited by 4 publications

References 11 publications

Comorbidities, Treatment and Survival Rates of Chronic Thromboembolic Pulmonary Hypertension in a Regional Centre

Comorbidities, Treatment and Survival Rates of Chronic Thromboembolic Pulmonary Hypertension in a Regional Centre

The long-term outcome of chronic thromboembolic pulmonary hypertension: Pulmonary endarterectomy and balloon pulmonary angioplasty

Computed Tomography Pulmonary Angiography Prediction of Adverse Long-Term Outcomes in Chronic Thromboembolic Pulmonary Hypertension: Correlation with Hemodynamic Measurements Pre- and Post-Pulmonary Endarterectomy

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