Pulmonary endarterectomy: experience and lessons learned in 1,500 cases

Jamieson, Stuart W.; Kapelanski, David P.; Sakakibara, Naohide; Manecke, Gerard R.; Thistlethwaite, Patricia A.; Kerr, Kim M.; Channick, Richard N.; Fedullo, Peter F.; Auger, William R.

doi:10.1016/s0003-4975(03)00828-2

Cited by 688 publications

(684 citation statements)

References 17 publications

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“…Increasing evidence shows incidence of residual PH after PEA ranging from 10.1%17 to ≈35%4 despite various definitions. In this study, 12 of 39 PEA survivors (30.8%) had residual PH (mPAP ≥25 mm Hg) several weeks after PEA, which is a frequency similar to previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…PEA has an advantage for lesions in lobular and segmental arteries17 in contrast to subsegmental arteries as favorable BPA targets (Table 5). Although our previous report targeting inoperable CTEPH showed that the average balloon size used was 4.35±1.78 mm,13 we used smaller balloons (3.53±1.31 mm) in these 10 cases, suggesting that most residual lesions were located at more peripheral sites.…”

Section: Discussionmentioning

confidence: 99%

“…PEA was performed using techniques similar to those established by the San Diego group 17, 23. Bilateral PEA adopted the median sternotomy under the institution of cardiopulmonary bypass.…”

Section: Methodsmentioning

confidence: 99%

“…Residual pulmonary hypertension (PH) after PEA occurs in ≈10% to 35% of patients4, 8, 17, 18, 19 and is the issue to be solved. It can cause persistent symptoms.…”

mentioning

confidence: 99%

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Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Yanaka

Nakayama

Shinke

et al. 2018

JAHA

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BackgroundResidual symptoms after pulmonary endarterectomy (PEA) remain as the clinical issues to be solved. Additional balloon pulmonary angioplasty (BPA) after PEA showed its efficacy with symptoms in a case series, although long‐term spontaneous recovery of exercise ability after PEA was also reported. However, no studies have validated the clinical efficacy of additional BPA by directly comparing PEA with and without BPA. The aim of this study was to retrospectively evaluate the efficacy of additional BPA as a sequential hybrid therapy for chronic thromboembolic pulmonary hypertension after PEA.Methods and ResultsAmong 44 patients with chronic thromboembolic pulmonary hypertension, 20 patients had residual symptoms after PEA. Of those, 10 patients underwent additional BPA (hybrid group) and were compared with the other 10 patients, who were followed up without BPA (PEA group). The period from PEA to additional BPA was 7.3±2.3 months. In hybrid group, mean pulmonary arterial pressure was significantly improved by PEA (40.6±1.8 to 26.9±3.1 mm Hg, P=0.001) and improved further (to 16.7±1.8 mm Hg, P=0.002) with additional BPA, which resulted in remarkable improvement in World Health Organization (WHO) functional class (pre‐ to post‐BPA: class I/II/III/IV, 0/5/4/1 to 7/3/0/0; P<0.001). Compared with the PEA group at follow‐up, the hybrid group achieved better mean pulmonary arterial pressure (18.7±1.7 versus 30.2±3.2 mm Hg, P=0.008), WHO functional class (class I/II/III/IV, 7/3/0/0 versus 0/8/2/0; P=0.001), and 6‐minute walking distance (429±38 versus 319±22 m, P=0.028).ConclusionsA sequential hybrid strategy improved residual symptoms and exercise capacity compared with single‐PEA therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…PEA was performed using techniques similar to those established by the San Diego group 17, 23. Bilateral PEA adopted the median sternotomy under the institution of cardiopulmonary bypass.…”

Section: Methodsmentioning

confidence: 99%

“…Residual pulmonary hypertension (PH) after PEA occurs in ≈10% to 35% of patients4, 8, 17, 18, 19 and is the issue to be solved. It can cause persistent symptoms.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Yanaka

Nakayama

Shinke

et al. 2018

JAHA

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“…3 The treatment of choice is a pulmonary endarterectomy, providing a potential cure for the disease. 4 In this procedure the fibrotic material is removed from the proximal pulmonary arteries. However, in some patients endarterectomy is not an option due to severe comorbidity or the predominant involvement of distal pulmonary arteries.…”

mentioning

confidence: 99%

Long-term efficacy of bosentan in inoperable chronic thromboembolic pulmonary hypertension

Post¹,

Plokker²,

Kelder³

et al. 2009

NHJL

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Background. Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is associated with a poor survival. Objectives. To evaluate the long-term response to a dual endothelin receptor antagonist in patients with inoperable CTEPH. Methods. All consecutive 18 patients (mean age 63±14 years) treated with bosentan for symptomatic inoperable CTEPH were included. Efficacy was evaluated by the log value of serum levels of N-terminal-pro brain natriuretic peptide (log NTpro BNP), New York Heart Association functional class (NYHA), and the six-minute walk test (6-MWT). All follow-up data (median 31 months) were compared with baseline and divided into: short-term (<12 months), mid-term (between 12 and 24 months), and long-term follow-up (>24 months). Results. At baseline, 15 patients were in NYHA class III and three in NYHA class IV, mean log NT-pro BNP level was 7.2±1.4 log pg/ml, and mean 6-MWT distance was 404±125 m. During short-term follow-up (n=18), the NYHA class improved (p=0.001), 6-MWT distance increased by 33 m (p=0.03), and log NT-pro BNP decreased to 6.9±1.4 log pg/ml (p=0.007). During mid-term follow-up (n=17), the NYHA class improved (p<0.001), the mean 6-MWT distance increased by 41 m (p=0.01), and log NT-pro BNP was 6.9±1.4 log pg/ml (p=0.31). During late followup (n=14) the NYHA class was still improved (p=0.03), the 6-MWT distance decreased by 9 m (p=0.73), and log NT-pro BNP was 7.1±1.5 log pg/ml (p=0.91). The overall four year survival rate was 88%. Conclusion: Bosentan seems to be effective during long-term treatment in patients with inoperable CTEPH. (Neth Heart J 2009;17:329-33).

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Increasing Hypoxemia and Dyspnea in Mild Chronic Obstructive Pulmonary Disease

Medarov

Chaudhry

Myint

2017

JAMA

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A man with a 3-year history of chronic obstructive pulmonary disease presented with increasing dyspnea on exertion, requiring increasing flow rates of oxygen. He was a former smoker with a 50-pack-year history. He had been diagnosed with stage I low-grade prostate cancer several years previously.Lung examination showed no wheezing. Cardiac examination showed a prominent pulmonary component (P 2 ) of the second heart sound. Noncontrast computed tomography of the chest was unremarkable.An echocardiogram revealed dilated right atrium and ventricle. Spirometry showed mild airway obstruction. Duplex ultrasound showed a nonocclusive thrombus in the left femoral and popliteal veins. Catheterization of the right side of the heart showed a pulmonary arterial pressure of 79/32 mm Hg (mean, 48 mm Hg) with a normal pulmonary capillary wedge pressure. A ventilation-perfusion (V/Q) scan was obtained (Figure, panel A), followed by pulmonary angiography (Figure, panel B).

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Pulmonary endarterectomy: experience and lessons learned in 1,500 cases

Cited by 688 publications

References 17 publications

Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Sequential Hybrid Therapy With Pulmonary Endarterectomy and Additional Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension

Long-term efficacy of bosentan in inoperable chronic thromboembolic pulmonary hypertension

Increasing Hypoxemia and Dyspnea in Mild Chronic Obstructive Pulmonary Disease

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