Predictors of Outcomes After Surgery for Chronic Thromboembolic Pulmonary Hypertension

Sakurai, Yasuhisa; Takami, Yoshiyuki; Amano, Kazuyuki; Higuchi, Yoshiro; Akita, Kiyotoshi; Noda, Mika; Tochii, Masato; Ishida, Michiko; Ishikawa, Hiroshi; Ando, Motomi; Takagi, Yasushi

doi:10.1016/j.athoracsur.2019.03.100

Cited by 15 publications

(20 citation statements)

References 23 publications

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“…The lengths of intensive care unit (ICU) and in-hospital stays were reported by eight and six studies, respectively, with values ranging from 4 [ 24 , 29 ] to 10 [ 30 ] days and from 12.6 [ 32 ] to 45 [ 33 ] days, respectively.…”

Section: Resultsmentioning

confidence: 99%

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

Faccioli

Verzeletti

Marra

et al. 2022

JCM

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Pulmonary endarterectomy (PEA) is the treatment of choice in case of chronic thromboembolic pulmonary hypertension (CTEPH). PEA is performed by an increasing number of surgeons; however, the reported outcomes are limited to a few registries or to individual centers’ experiences. This systematic review focuses on pre-operative evaluation, intra-operative procedure and post-operative results in patients submitted to PEA for CTEPH. The literature included was searched using a formal strategy, combining the terms “pulmonary endarterectomy” AND “chronic pulmonary hypertension” and focusing on studies published in the last 5 years (2017–2022) to give a comprehensive overview on the most updated literature. The selection of the adequate surgical candidate is a crucial point, and the decision should always be performed by expert multidisciplinary teams composed of surgeons, pulmonologists and radiologists. In all the included studies, the surgical procedure was performed through a median sternotomy with intermittent deep hypothermic circulatory arrest under cardiopulmonary bypass. In case of residual pulmonary hypertension, alternative combined treatments should be considered (balloon angioplasty and/or medical therapy until lung transplantation in highly selected cases). Short- and long-term outcomes, although not homogenous across the different studies, are acceptable in highly experienced CTEPH centers.

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Section: Resultsmentioning

confidence: 99%

“…Residual PH rates after PEA ranged from 8.2% [ 32 ] to 41.9% [ 34 ], and they were reported in seven studies. The overall survival rate, reported in five studies, ranged from ~82.5% [ 29 ] to 98% [ 35 ] at 1 year and from 77% [ 29 ] to 89.2% [ 33 ] at 5 years. Data on short- and long-term outcomes are reported in Table 3 .…”

Section: Resultsmentioning

confidence: 99%

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

Faccioli

Verzeletti

Marra

et al. 2022

JCM

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“…PTE is the definitive treatment of CTEPH [ 1 ] . From its evolution of embolectomy to the current standard thromboendarterectomy, it cannot be over emphasized that complete clearance of the organized thrombus in the correct plane is vital for good outcomes [ 8 ] . Utley et al [ 9 ] emphasized that circulatory arrest was absolutely essential for distal segmental vessel thromboendarterectomy because of the increased bronchial circulation.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Thromboendarterectomy Without Circulatory Arrest

Kynta¹,

Rawat²,

Mandal³

et al. 2022

Braz J Cardiovasc Surg

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Introduction Here we describe our technique and results of beating heart pulmonary thromboendarterectomy (PTE) with cardiopulmonary bypass (CPB) in four patients for treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Methods Retrospective analysis of data from patients who underwent PTE for CTEPH between January 2019 and September 2020. Patients were followed up with clinical assessment, 2D echocardiography, and computed tomography pulmonary angiogram. Results Four patients were operated for CTEPH using our technique. Moderate tricuspid regurgitation (TR) and severe TR were found in two patients each. Severe right ventricular (RV) dysfunction was found in all cases. Thrombi were classified as Jamieson type II in three cases and type I in one case. Postoperative median direct manometric pulmonary artery (PA) pressures decreased (from 46.5 mmHg to 23.5 mmHg), median CPB time was 126 minutes, and median temperature was 33.35 °C. Mechanical ventilation was for a median of 19.5 hours. There was one re-exploration. Median intensive care unit stay was 7.5 days. There was no mortality. Postoperative 2D echocardiography revealed decrease in median PA systolic pressures (from 85 mmHg to 33 mmHg), improvement in RV function by tricuspid annular plane systolic excursion (median 14 mm vs . 16 mm), and improved postoperative oxygen saturations (88.5% vs . 99%). In follow-up (ranging between 2-15 months), all patients reported improvement in quality of life and were in New York Heart Association class I. Conclusion With our described simple modifications, advances in perfusion, and blood conservation technologies, one can avoid the need for deep hypothermic circulatory arrest during PTE.

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“…Pre-and post-operative PVR, pulmonary vasoreactivity, as well as age, comorbidities and functional status are factors assisting in the prediction of post-operative outcomes (10,11,12). Persistent/recurrent PH after PEA is a major determinant of poor prognosis and functional capacity for CTEPH patients undergoing PEA (7,13). According to the European registry, 16.7% of patients are diagnosed with persistent/recurrent PH after PEA (14).…”

Section: Pulmonary Endarterectomy -An Old Technique Newly Stimulatedmentioning

confidence: 99%

Treating the “Untreatable”. Recent advances in chronic thromboembolic pulmonary hypertension

Shafran¹,

Lang²

2020

Cardiologia Hungarica

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Chronic thromboembolic pulmonary hypertension (CTEPH) is thought to result from incomplete resolution of pulmonarterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA) with low post-operative mortality and good long-term survival in expert hands. Patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery have been previously the "Untreatable". Modern CTEPH man agement has now a solution for those previous no-option patients: balloon pulmonary angioplasty (BPA), and targeted medical therapies. Riociguat has been approved for inoperable CTEPH, and persistent-recurrent PH after PEA, and report that BPA improves haemodynamic, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel review summarises available evidence for PEA, BPA, and medical therapy, patient selection, peri-procedural imaging

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Predictors of Outcomes After Surgery for Chronic Thromboembolic Pulmonary Hypertension

Cited by 15 publications

References 23 publications

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

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

Pulmonary Thromboendarterectomy Without Circulatory Arrest

Treating the “Untreatable”. Recent advances in chronic thromboembolic pulmonary hypertension

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