Outcome after pulmonary endarterectomy for segmental chronic thromboembolic pulmonary hypertension

Perrot, Marc de; Donahoe, Laura; McRae, Karen; Thenganatt, John; Moric, Jakov; Chan, Justin; McInnis, Micheal; Jumaa, Klaudia; Tan, Kong Teng; Mafeld, Sebastian; Granton, John; Weatherald, Jason; Hirani, Naushad; Thakrar, Mitesh V.; Helmersen, Doug; Swiston, John R.; Brunner, Nathan W.; Levy, Robert D.; Mehta, Sanjay; Kapasi, A.; Lien, Dale; Michelakis, Evangelos D.; Hernández, Paul; Kemp, Kristina; Hirsch, Andrew; Langleben, David; Hambly, Nathan; Dorasamy, Punginathn; D’Arsigny, Christine L.; Chandy, George; Mielniczuk, Lisa; Christiansen, David Høyrup; Fox, George E.; Laframboise, Karen; Provencher, Steeve

doi:10.1016/j.jtcvs.2021.10.078

Cited by 14 publications

(8 citation statements)

References 23 publications

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“…This emphasizes our belief, in accordance with recommendations from multiple guidelines, that evaluation at an experienced PTE center is essential in selecting the appropriate treatment. Importantly, PTE can be performed safely and effectively in patients with exclusively distal disease as shown by de Perrot and colleagues 21 who demonstrated similar mortality (2.8% vs 2.4%: p = 0.8) comparing 401 consecutive patients at a single center with Jamieson III versus I and II. One‐year survival was also similar (7.7% vs. 5.5%; p = 0.4) but patients with Jamieson III were more likely to require additional treatment with PH‐targeted medical therapy of BPA.…”

Section: Discussionmentioning

confidence: 74%

Patient selection for balloon pulmonary angioplasty: Six‐year results from a high volume PTE surgical center

et al. 2022

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Chronic thromboembolic pulmonary hypertension (CTEPH) is the result of incompletely resolved pulmonary emboli (PE) that lead to chronic right heart failure. The two mechanical treatment options are pulmonary thromboendarterectomy (PTE) and balloon pulmonary angioplasty (BPA). There are no formal criteria for BPA patient selection and treatment decisions vary according to a center's experience with BPA and PTE. We performed a retrospective review of consecutive patients treated with PTE and BPA at UCSD from March 2015 to 2021. Clinical and hemodynamic data were collected. Patients were categorized according to the rationale for BPA. One hundred fifty three patients underwent 643 BPA sessions, and 1104 patients underwent PTE. Patients selected for PTE had worse baseline hemodynamics with mean pulmonary artery pressure 41.1 ± 11.7 versus 34.6 ± 11.2 mmHg, p < 0.001. 59% of patients selected for BPA had surgically inaccessible disease, 21% had residual CTEPH after PTE, 10% had a discordance between disease burden and symptoms/hemodynamics, 7% had comorbidities that prevented PTE and 3% refused PTE surgery. 28% of patients who underwent PTE had exclusively level III or IV disease based on surgical specimen. There were no BPA procedure‐related mortalities and minor pulmonary vascular complication rates during BPA were 9.2%. The most common reason for BPA selection was surgically inaccessible disease followed by residual CTEPH after PTE. Almost one third of patients who underwent PTE had exclusively distal disease by surgical criteria and might have been directed to BPA at a less experienced surgical center.

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Section: Discussionmentioning

confidence: 74%

Patient selection for balloon pulmonary angioplasty: Six‐year results from a high volume PTE surgical center

et al. 2022

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“…This emphasizes our belief, in accordance with recommendations from multiple guidelines, that evaluation at an experienced PTE center is essential in selecting the appropriate treatment. Importantly, PTE can be performed safely and effectively in patients with exclusively distal disease as shown by de Perrot and colleagues 21 who demonstrated similar mortality (2.8% vs 2.4%: p = 0.8) comparing 401 consecutive patients at a single center with Jamieson III versus I and II. Oneyear survival was also similar (7.7% vs. 5.5%; p = 0.4) but patients with Jamieson III were more likely to require additional treatment with PH-targeted medical therapy of BPA.…”

Section: Discussionmentioning

confidence: 74%

Characteristics of Patients Treated with Balloon Pulmonary Angioplasty at a High-Volume Pulmonary Thromboendarterectomy Center: Single Center USA Experience

Yang

Poch

Bautista

et al. 2022

C105. Civic Center: Pulmonary Vascular Disease

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Chronic thromboembolic pulmonary hypertension (CTEPH) is the result of incompletely resolved pulmonary emboli (PE) that lead to chronic right heart failure. The two mechanical treatment options are pulmonary thromboendarterectomy (PTE) and balloon pulmonary angioplasty (BPA). There are no formal criteria for BPA patient selection and treatment decisions vary according to a center's experience with BPA and PTE. We performed a retrospective review of consecutive patients treated with PTE and BPA at UCSD from March 2015 to 2021. Clinical and hemodynamic data were collected. Patients were categorized according to the rationale for BPA. One hundred fifty three patients underwent 643 BPA sessions, and 1104 patients underwent PTE. Patients selected for PTE had worse baseline hemodynamics with mean pulmonary artery pressure 41.1 ± 11.7 versus 34.6 ± 11.2 mmHg, p < 0.001. 59% of patients selected for BPA had surgically inaccessible disease, 21% had residual CTEPH after PTE, 10% had a discordance between disease burden and symptoms/hemodynamics, 7% had comorbidities that prevented PTE and 3% refused PTE surgery. 28% of patients who underwent PTE had exclusively level III or IV disease based on surgical specimen. There were no BPA procedure-related mortalities and minor pulmonary vascular complication rates during BPA were 9.2%. The most common reason for BPA selection was surgically inaccessible disease followed by residual CTEPH after PTE. Almost one third of patients who underwent PTE had exclusively distal disease by surgical criteria and might have been directed to BPA at a less experienced surgical center.

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“…27 Currently, PTE is indicated in patients with segmental and subsegmental pulmonary artery disease with acceptable mid-and long-term results. 6,8,[12][13][14][17][18][19]21,[23][24][25] On the other hand, the balloon pulmonary angioplasty treatment for chronic PA occlusion is a novel technique for the primary treatment of CTHE and secondary treatment for residual PA thrombosis after PTE. 8,11,21,27 Brain hypoperfusion during hypothermia and CA affect brain metabolism and induce apoptosis and death of nerve cells.…”

Section: Hypothermic Circulatory Arrest With Total Arrest Is Anmentioning

confidence: 99%

“…In patients who undergo thoracic aorta surgery under HCA, brain perfusion is maintained via antegrade cerebral perfusion during CA, while in patients undergoing PTE all perfusion is stopped during CA. 2,3,6,28,29 The incidence of postoperative neurological dysfunctions after elective aortic arch replacement or acute type A aortic dissection is 10%-21%, while after PTE 7%-20%. 2,3,15,[17][18][19][20][21][22][23][24][25][26][27]29,30 Although many studies have reported the general outcome after PTE, the incidence of postoperative neurological dysfunction is unclear and more data are needed to confirm it.…”

Section: Hypothermic Circulatory Arrest With Total Arrest Is Anmentioning

confidence: 99%

“…[1][2][3] In addition, a hypothermic circulatory arrest is used for surgical pulmonary thromboendarterectomy (PTE). [4][5][6] Intervals with circulatory arrest (CA) offer a clear surgical field for removing the thrombus and emboli from the pulmonary artery (PA) branches. 4 The price to pay for intermittent total CA during PTE is postoperative neurological dysfunction due to brain hypothermia and hypoperfusion.…”

mentioning

confidence: 99%

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Can regional cerebral oxygen saturation monitoring during circulatory arrest time predict postoperative neurological dysfunction in patients undergoing surgical pulmonary thromboendarterectomy? Useful index for short‐ and long‐term outcomes

Samanidis

Kanakis

2022

Journal of Cardiac Surgery

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A hypothermic circulatory arrest is usually used to correct thoracic aorta pathologies.The emergency treatment of acute type A aortic dissection and elective repair of aortic arch pathologies are the most common indications for using hypothermic circulatory arrest. A hypothermic circulatory arrest can also be used for surgical pulmonary thromboendarterectomy in patients with chronic thromboembolic | © 2022 Wiley Periodicals LLC.

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Outcome after pulmonary endarterectomy for segmental chronic thromboembolic pulmonary hypertension

Cited by 14 publications

References 23 publications

Patient selection for balloon pulmonary angioplasty: Six‐year results from a high volume PTE surgical center

Patient selection for balloon pulmonary angioplasty: Six‐year results from a high volume PTE surgical center

Characteristics of Patients Treated with Balloon Pulmonary Angioplasty at a High-Volume Pulmonary Thromboendarterectomy Center: Single Center USA Experience

Can regional cerebral oxygen saturation monitoring during circulatory arrest time predict postoperative neurological dysfunction in patients undergoing surgical pulmonary thromboendarterectomy? Useful index for short‐ and long‐term outcomes

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