Perioperative Management of Pulmonary Endarterectomy—Perspective from the UK National Health Service

Ng, Oriana; Giménez-Milà, Marc; Jenkins, David P.; Vuylsteke, Alain

doi:10.1053/j.jvca.2018.11.033

Cited by 3 publications

(4 citation statements)

References 78 publications

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“…21-17 23 Next to reperfusion lung edema, peri-and postoperative bleeding events are feared 18 complications. 7 Our findings demonstrated less often bleeding complications such as 19 hemopneumothorax or hemopericardium with a rate of 0.8% and 1.9%, respectively compared 20 to previous studies. 24,25 However, despite those bleeding events occurred rarely in the Germany 21 NIS, the present study identified hemopneumothorax and hemopericardium independently 22 predicting in-hospital mortality.…”

supporting

confidence: 55%

“…18 Interestingly, Germany has a similar proportion of CTEPH patients referred to surgery (per one million inhabitants per year) to the UK (each 2.7 PEAs) but more compared to the rest of Europe (1.7 PEAs per one million inhabitants per year) or substantially more compared to the US (0.9 PEAs per one million inhabitants per year). 7,8 The in-hospital mortality rate was 6.8% over the entire 11-year time period. This is in line with previously reported short-term mortality rates, which ranged between 2.2 and 16.0%.…”

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

confidence: 98%

“…2 Notably, a greater proportion of CTEPH patients per one million inhabitants referred for surgery in the UK and Europe compared to the United States. 7,8 Although the principal technique of endarterectomy has not changed, 9 PAH-specific medical therapy is frequently used as an additional treatment approach before PEA and the complex and close collaboration of a multidisciplinary team including pulmonologists, cardiothoracic surgeons, radiologists, and anesthesiologists became an increasingly important factor. 10,11 Progress in surgical experience and perioperative management as well as improvement in medical therapy over the past decade has considerably improved the outcome of patients with CTEPH, but a large study investigating time trends of patient characteristics and predictors of inhospital outcomes for CTEPH patients treated with PEA are still missing.…”

Section: Introductionmentioning

confidence: 99%

“…4,13,14 inhabitants per year). 7,8 The in-hospital mortality rate was 6.8% over the entire 11-year time 2 period. This is in line with previously reported short-term mortality rates, which ranged between 3 2.2% and 16.0%.…”

mentioning

confidence: 97%

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

et al. 2021

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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.

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supporting

confidence: 55%

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

confidence: 98%