Perfusion strategy and mid-term results of 58 consecutive pulmonary endarterectomy

Abstract

Objective: The aim of this retrospective study was to review and report short-term and mid-term outcomes of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension at our institute in the recent 2 years and to describe perfusion strategy. Methods: A total of 58 consecutive patients with chronic thromboembolic pulmonary hypertension underwent pulmonary endarterectomy under deep hypothermia circulatory arrest with an established perfusion practice between November 2015 and December 2017. Peri-operative data and patients’ outcome were retrospectively analyzed. Results: Mean pulmonary artery pressure was decreased (49 (40-56) mmHg vs 27 (20-31) mmHg, p < 0.001), and pulmonary vascular resistance (724 (538-1108) vs 206 (141-284) dyn second cm−5, p < 0.001) improved significantly after surgery. In-hospital mortality was 1.7% and postoperative complication rate was 27.6%. Antipsychotic medication of olanzapine was prescribed for 36 patients (62.1%), which was independently related to total deep hypothermic circulatory arrest time, postoperative blood potassium concentration, and hematocrit. The majority of patients recovered uneventfully with good mid-term cardiac function (New York Heart Association I-II: 98.1%) and neurological outcome (Glasgow Outcome Scale—Extended Upper Good Recovery: 74.1% and Lower Good Recovery: 20.3%). Mid-term neurological outcome was associated with post–pulmonary endarterectomy antipsychotic medication. Conclusion: Short-term and mid-term outcome after pulmonary endarterectomy was comparable to high-volume centers. Incidence of post–pulmonary endarterectomy delirium was relatively high and associated with mid-term neurological outcome. Total deep hypothermic circulatory arrest time, postoperative blood potassium concentration, and hematocrit were independent risk factors of postoperative olanzapine medication. More efforts and further research are required to optimize the neuroprotection of perfusion practice.

Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review of the Most Updated Literature

“…Five studies reported data about the need for post-operative extracorporeal membrane oxygenation (ECMO) support, with rates ranging from 3.5% [ 31 ] to 9% [ 28 ].…”

Surgical treatment of pulmonary artery sarcoma: a report of 17 cases

“… 8 The process of CPB with DHCA for PEA had been described in detail previously. 9 Once CPB was initiated, active cooling was started with a heat-cool machine, a cooling head device, and cooling blanket. During the cooling period, some preliminary dissection was performed.…”

“…PEA was performed on both sides following the standard procedure with deep hypothermic circulatory arrest (DHCA) or deep hypothermic low flow established by the University of California San Diego (UCSD) group 8 . The process of CPB with DHCA for PEA had been described in detail previously 9 . Once CPB was initiated, active cooling was started with a heat‐cool machine, a cooling head device, and cooling blanket.…”

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

“…The mean pulmonary artery pressure and pulmonary vascular resistance were significantly decreased after PTE (for both p < .05), while in-hospital mortality was 6.1%. On the other hand, postoperative neurological dysfunction was observed in 11 (13.4%) patients and most of these patients (7) had mild neurological disorders postoperatively. In patients with postoperative neurological dysfunction, the rSO 2 was lower by 38% and the duration of rSO 2 < 40% was 4 min.…”

“…Hypothermic circulatory arrest with total arrest is an established technique for PTE in patients with CTEPH. In the last 3 years, many studies from national databases have reported outcomes after surgical PTE in literature 6–26 . A recent publication from the International Society of Heart Lung Transplantation presents the current aspects of the management and treatment of patients with CTEPH and surgical PTE 21 .…”