Outcome after surgical treatment of chronic thromboembolic pulmonary hypertension: dealing with different patient subsets. A single-centre experience

Nierlich, Patrick; Hold, Alina; Ristl, Robin

doi:10.1093/ejcts/ezw099

Cited by 20 publications

(19 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study, conducted in a large cohort of consecutive patients with CTEPH, confirms the results of the international CTEPH Registry that PEA is an independent predictor of survival [24]. In operated patients it was associated with an excellent long-term outcome with an estimated 5-year survival of 83%, similar to data from the international [24], Austrian [31, 32], Spanish [25], Italian [33] and Dutch CTEPH registries [34]. Although 482 patients (82%) had technically operable disease distribution, despite the proven benefits of PEA only 272 (49% of the total cohort) underwent surgery.…”

Section: Discussionsupporting

confidence: 87%

The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension

et al. 2018

View full text Add to dashboard Cite

Pulmonary endarterectomy (PEA) is the gold standard treatment for operable chronic thromboembolic pulmonary hypertension (CTEPH). However, a proportion of patients with operable disease decline surgery. There are currently no published data on this patient group. The aim of this study was to identify outcomes and prognostic factors in a large cohort of consecutive patients with CTEPH.Data were collected for consecutive, treatment-naive CTEPH patients at the Pulmonary Vascular Disease Unit of the Royal Hallamshire Hospital (Sheffield, UK) between 2001 and 2014.Of 550 CTEPH patients (mean±sd age 63±15 years, follow-up 4±3 years), 49% underwent surgery, 32% had technically operable disease and did not undergo surgery (including patient choice n=72 and unfit for surgery n=63), and 19% had inoperable disease due to disease distribution. The 5-year survival was superior in patients undergoing PEA (83%) technically operable disease who did not undergo surgery (53%) and inoperable due to disease distribution (59%) (p<0.001). Survival was superior in patients following PEA compared with those offered but declining surgery (55%) (p<0.001). In patients offered PEA, independent prognostic factors included mixed venous oxygen saturation, gas transfer and patient decision to proceed to surgery.Outcomes in CTEPH following PEA are excellent and superior to patients declining surgery, and strongly favour consideration of a surgical intervention in eligible patients.

show abstract

Section: Discussionsupporting

confidence: 87%

The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension

et al. 2018

View full text Add to dashboard Cite

show abstract

“…[4][5][6] Predictors of in-hospital mortality in the German NIS Regarding predictors of mortality, the UK-PH registry demonstrated in 239 CTEPH patients that a preoperative pulmonary resistance above 1000 dyneÁsÁcm À5 was associated with increased perioperative mortality, whereas higher cardiac index and longer six-minute walk distance were associated with a better perioperative survival. 16 Similarly, an elevated PVR as well as NYHA class IV were identified as a predictor of 30-day mortality in 214 19 and 106 20 CTEPH patients who underwent PEA in previous studies. In the present study, NYHA class III/IV was also associated with increased in-hospital mortality in an univariate, but not in a multivariate logistic regression model.…”

Section: Comparison Of the German Nis With Other Study Cohorts Worldwidementioning

confidence: 73%

Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension

et al. 2021

View full text Add to dashboard Cite

Chronic thromboembolic pulmonary hypertension (CTEPH) is considered as a rare but severe complication after acute pulmonary embolism (PE) and is potentially curable by pulmonary endarterectomy (PEA). We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of PEA in CTEPH patients and to investigate predictors of the in-hospital course. We analyzed data on the characteristics, comorbidities, treatments and in-hospital outcomes for all CTEPH patients treated with PEA in the German nationwide inpatient sample between 2006 and 2016. Overall, 1,398 inpatients were included. Annual number of PEA increased from 67 in 2006 to 194 in 2016 (P<0.001), in parallel with a significant decrease of in-hospital mortality (10.9% in 2008 to 1.5% in 2016; P<0.001). Patientsâ characteristics shifted slightly towards older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Independent predictors of in-hospital mortality were age (OR 1.03 [95%CI 1.01-1.05]; P=0.001), right heart failure (2.55 [1.37-4.76]; P=0.003), in-hospital complications such as ischemic stroke (6.87 [1.06-44.70]; P=0.044) and bleeding events like hemopneumothorax (24.93 [6.18-100.57]; P<0.001). Annual PEA volumes per center below 10 annual procedures were associated with higher rates of adverse in-hospital outcomes. Annual numbers of CTEPH patients treated with PEA increased markedly in Germany between 2006 and 2016, in parallel with a decrease of in-hospital mortality. Our findings suggest that perioperative management of PEA, institutional experience and patient-selection are crucial and have improved over time.

show abstract

“…Data on the outcomes of lung transplantation in CTEPH can be extracted from only a few reported experiences and they are not satisfactory. Nierlick et al (3) reported that 3 of the 4 transplanted patients died shortly after the intervention due to multi-organs failure while the last patient had a good long-term outcome after transplantation. More recently, the systematic application of intraoperative cardio-circulatory support and its prolongation in the postoperative period have improved the surgical results of lung transplantation for PH even in case of CTEPH.…”

Section: Discussionmentioning

confidence: 99%

End-stage chronic thromboembolic pulmonary hypertension: is there still room for lung transplantation?—the past, the present and the future

Faccioli¹,

Dell’Amore²

2022

Ann Cardiothorac Surg

View full text Add to dashboard Cite

Outcome after surgical treatment of chronic thromboembolic pulmonary hypertension: dealing with different patient subsets. A single-centre experience

Cited by 20 publications

References 23 publications

The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension

The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension

Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension

End-stage chronic thromboembolic pulmonary hypertension: is there still room for lung transplantation?—the past, the present and the future

Contact Info

Product

Resources

About