Outcome After Pulmonary Thromboendarterectomy

Archibald, Carol; Auger, William R.; Fedullo, Peter F.

doi:10.1016/s1043-0679(99)70009-2

Cited by 24 publications

(24 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the second, beraprost trial [30], in accordance with the absence of a clinical benefit, none of the MLHF scores was found to have improved. However, in patients with CTEPH, pulmonary endarterectomy resulted in an impressive improvement in HRQOL measured by the SF-36 [31]. Post-operatively, the patients scored only four out of eight composite health concepts slightly lower compared with the normal population.…”

Section: Quality Of Life In Pulmonary Hypertension E Cenedese Et Almentioning

confidence: 89%

Measurement of quality of life in pulmonary hypertension and its significance

Cenedese¹

2006

Eur Respir J

136

112

View full text Add to dashboard Cite

Until recently, assessment of patients with pulmonary hypertension has mainly relied on functional and haemodynamic parameters. Health-related quality of life (HRQOL), however, has become increasingly important in defining overall health status.The present study investigated the performance and clinical relevance of the Minnesota Living with Heart Failure (MLHF) questionnaire by prospectively studying 48 patients with either pulmonary arterial hypertension (n526) or chronic thromboembolic pulmonary hypertension (n522). The MLHF scores were correlated to various clinical and haemodynamic parameters. Prognostic outcome was evaluated by calculating the time taken to reach an adverse clinical event defined as death, lung transplantation or pulmonary endarterectomy.The reliability of test-re-test and internal consistency of this HRQOL tool was high. The MLHF score and its physical subscore correlated moderately to well with functional and haemodynamic parameters, except in the case of pulmonary artery pressures. Both scores significantly improved during vasodilator therapy. This figure was surpassed only by the New York Heart Association/ World Health Organization functional class. A multivariate analysis of all variables revealed that the MLHF score was the sole factor predicting subsequent outcome.The Minnesota Living with Heart Failure questionnaire is highly reproducible, consistent, and a moderately valid and responsive tool in assessing health-related quality of life in pulmonary hypertension. Moreover, it is a significant predictor of outcome in these patients.

show abstract

Section: Quality Of Life In Pulmonary Hypertension E Cenedese Et Almentioning

confidence: 89%

Measurement of quality of life in pulmonary hypertension and its significance

Cenedese¹

2006

Eur Respir J

136

112

View full text Add to dashboard Cite

show abstract

“…Dadurch ist zunächst nur eine mäßige Reduktion des pulmonalen Hochdrucks zu beobachten. Dieser bildet sich erst im Verlauf parallel mit der Rechtshypertrophie zurück [1,16,17,23,29]. So konnten eigene Untersuchungen eine Reduktion des Widerstands um > 80% von im Mittel 1 945 auf 194 dyn · s · cm -5 nachweisen [23].…”

Section: Ergebnisseunclassified

“…So konnten eigene Untersuchungen eine Reduktion des Widerstands um > 80% von im Mittel 1 945 auf 194 dyn · s · cm -5 nachweisen [23]. Ähnliche Ergebnisse sind von anderen Arbeitsgruppen bestätigt worden [1,13,20,40].…”

Section: Ergebnisseunclassified

“…Berichte über Langzeitverläufe in der Literatur weisen eine Überlebensrate von > 75% nach 6 Jahren nach. In den Nachuntersuchungen werden die meisten Patienten funktionell den NYHA-Stadien I und II (New York Heart Association) zugeordnet [1,11,29].…”

Section: Ergebnisseunclassified

“…Die pulmonale Thrombendarteriektomie als Ausschälplastik der arteriellen Lungenstrombahn hat sich in der Behandlung der durch chronisch persistierende oder rezidivierende Lungenembolien bedingten pulmonalen Hypertonie etabliert und als potentiell kurative Therapieform erwiesen [1,13,22,26]. Die thromboembolische pulmonale Hypertonie ist somit eine chirurgisch beherrschbare Form des Lungenhochdrucks geworden.…”

Section: Introductionunclassified

See 2 more Smart Citations

Chirurgie der chronischen pulmonalen Druckerhöhung

Iversen

Felderhoff

2005

Herz

View full text Add to dashboard Cite

Bilateral pulmonary thromboendarterectomy has been recognized as the first-choice therapeutic option for patients with chronic thromboembolic pulmonary hypertension. With careful patient selection, meticulous surgical technique and careful postoperative management the surgical procedure has proven potentially curative for these often severely incapacitated patients in whom prognosis is otherwise poor. By means of pulmonary angiography and multislice CT correct diagnosis is established and the crucial question of operability determined.In the presence of significant exertional dyspnea and/or elevation of pulmonary vascular resistance surgery is indicated when the thromboembolic obstructions are determined accessible to surgical removal. Suboptimal surgical results may be obtained in patients with solely peripheral location of lesions, i. e., beginning at the bronchopulmonary segmental arteries, and correct patient selection becomes crucial especially in advanced stages of disease of very high pulmonary vascular resistance and presence of right heart failure.The surgical techniques are standardized with use of median sternotomy with cardiopulmonary bypass, deep hypothermia and periods of circulatory arrest and consist of complete dissection of the intimal layer of the pulmonary branches containing the thromboembolic lesions as a true endarterectomy technique.The reported operative mortality for pulmonary thromboendarterectomy differs in the literature between 4.5% and 23.5% and probably reflects not only the various experiences with this patient group but most likely also the disparate policies in patient selection. The authors' experience comprises 250 surgically treated patients with an operative mortality of 14.4%. The immediate hemodynamic and functional improvement of patients following successful thromboendarterectomy is excellent with further improvement during the first year. Pulmonary hypertension recurs over time in a few patients because of embolism, thrombosis or progression of reactive vasculopathy. However, the functional improvement and decrease of right ventricular afterload are persistent in the vast majority.Given the poor results of lung transplantation, this is not an alternative, and patients with chronic thromboembolic pulmonary hypertension should undergo thromboendarterectomy, preferably in the most early stage of their disease.

show abstract

Pulmonale Thrombembolektomie und pulmonale Thrombendarteriektomie

Iversen

2010

Herzchirurgie

View full text Add to dashboard Cite

Outcome After Pulmonary Thromboendarterectomy

Cited by 24 publications

References 22 publications

Measurement of quality of life in pulmonary hypertension and its significance

Measurement of quality of life in pulmonary hypertension and its significance

Chirurgie der chronischen pulmonalen Druckerhöhung

Pulmonale Thrombembolektomie und pulmonale Thrombendarteriektomie

Contact Info

Product

Resources

About