Pulmonary endarterectomy for distal chronic thromboembolic pulmonary hypertension

D’Armini, Andrea Maria; Morsolini, Marco; Mattiucci, Gabriella; Grazioli, Valentina; Pin, Maurizio; Valentini, Adele; Silvaggio, Giuseppe; Klersy, Catherine; Dore, Roberto

doi:10.1016/j.jtcvs.2014.06.052

Cited by 116 publications

(83 citation statements)

References 29 publications

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“…Surgery is generally most effective in patients with type 1 and 2 disease; however, in experienced units many patients with type 3 disease benefit from PEA, even if there is some persistent PH [16]. In this regard, a recent study of 331 endarterectomies that classified patients into two groups (type 1 and 2 versus type 3 disease) reported in-hospital mortality of 6.9%, which did not differ between groups [28].…”

Section: Effectiveness Of Pea and Survival Ratesmentioning

confidence: 99%

Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension

2015

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Pulmonary endarterectomy (PEA) is the treatment of choice to relieve pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH). It is a complex surgical procedure with a simple principle: removal of obstructive thromboembolic material from the pulmonary arteries in order to reduce pulmonary vascular resistance, relieve pulmonary hypertension (PH) and alleviate right ventricular dysfunction. In the majority of patients there is symptomatic and prognostic benefit. However, not all patients with CTEPH are suitable for treatment with PEA. Operability assessment is not always easy, being largely subjective and based on experience. It is therefore important that all patients are referred to an experienced CTEPH centre for careful evaluation of suitability for surgery. The most common reason for inoperability is distal vasculopathy accounting for a high proportion of the vascular resistance. Surgery requires cardiopulmonary bypass and periods of deep hypothermic circulatory arrest. Complications include reperfusion lung injury and persistent PH. However, with careful patient selection, surgical technique and post-operative management, PEA is a highly effective treatment with mortality rates <5% at experienced centres. Patients who are unsuitable for surgery may be candidates for medical therapy. @ERSpublications A review of pulmonary endarterectomy as a CTEPH treatment, including patient assessment, risks and outcomes http://ow.ly/L82F7

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Section: Effectiveness Of Pea and Survival Ratesmentioning

confidence: 99%

Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension

2015

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“…[8][9][10][11][12][13][14][15] Bridging therapy with PAH-targeted drugs before PEA may improve hemodynamics before PEA [16][17][18] but does not seem to affect post-PEA outcome and hemodynamics. 19 In inoperable patients, only small-size, single-center series of patients, treated with either intravenous prostacyclin analogs or oral PAH-targeted drugs, have been published, reporting 3-year survival varying from 41% to 80%.…”

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confidence: 99%

Long-Term Outcome of Patients With Chronic Thromboembolic Pulmonary Hypertension

et al. 2016

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C hronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism with uncertain prevalence, ranging from 0.4% to 9.1%. 1 Diagnosis is strongly associated with a history of acute venous thromboembolism (VTE). 2,3 It is caused by nonresolving fibrothrombotic obstructions of large pulmonary arteries, combined Background-Chronic thromboembolic pulmonary hypertension, a rare complication of acute pulmonary embolism, is characterized by fibrothrombotic obstructions of large pulmonary arteries combined with small-vessel arteriopathy. It can be cured by pulmonary endarterectomy, and can be clinically improved by medical therapy in inoperable patients. A European registry was set up in 27 centers to evaluate long-term outcome and outcome correlates in 2 distinct populations of operated and not-operated patients who have chronic thromboembolic pulmonary hypertension. Methods and Results-A total of 679 patients newly diagnosed with chronic thromboembolic pulmonary hypertension were prospectively included over a 24-month period. Estimated survival at 1, 2, and 3 years was 93% (95% confidence interval [CI], 90-95), 91% (95% CI, 87-93), and 89% (95% CI, 86-92) in operated patients (n=404), and only 88% (95% CI, 83-91), 79% (95% CI, 74-83), and 70% (95% CI, 64-76) in not-operated patients (n=275). In both operated and not-operated patients, pulmonary arterial hypertension-targeted therapy did not affect survival estimates significantly. Mortality was associated with New York Heart Association functional class IV (hazard ratio [HR], 4.16; 95% CI, 1. P=0.0065 and HR, 4.76; 95% CI, P=0.0021), increased right atrial pressure (HR, 1.34; 95% CI, 0.95-1.90; P=0.0992 and HR, 1.50; 95% CI, 1.20-1.88; P=0.0004), and a history of cancer (HR, 3.02; 95% CI, 1.36-6.69; P=0.0065 and HR, 2.15; 95% CI, 1.18-3.94; P=0.0129) in operated and not-operated patients, respectively. Additional correlates of mortality were bridging therapy with pulmonary arterial hypertension-targeted drugs, postoperative pulmonary hypertension, surgical complications, and additional cardiac procedures in operated patients, and comorbidities such as coronary disease, left heart failure, and chronic obstructive pulmonary disease in not-operated patients. Conclusions-The long-term prognosis of operated patients currently is excellent and better than the outcome of notoperated patients. with small-vessel arteriopathy in some patients. Both proximal and small-vessel obstruction increase pulmonary vascular resistance (PVR), leading to progressive pulmonary hypertension, right heart failure, and ultimately death. CTEPH can be cured by pulmonary endarterectomy (PEA) 4 and clinically improved by medical therapy. 5,6 Therefore, current guidelines recommend PEA as first-choice therapy, whereas the use of pulmonary arterial hypertension (PAH)-targeted drugs is restricted to inoperable patients or patients with persistent/recurrent pulmonary hypertension after PEA.7 Balloon pulmonary angioplasty, a new and promising treatment method for ...

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“…4-6 However, the surgical technique of PEA requires proficiency and thus the procedure is performed at limited numbers of institutions. [4][5][6][7][8] Patients deemed suitable for PEA are those in WHO functional class III or IV and with lesions mainly located in the lobar and segmental pulmonary arteries. Patients with lesions in the distal arteries and/or elderly patients and those with comorbidities have been considered to have an unfavorable risk/benefit ratio and are often deemed inoperable.…”

Section: Bpa For Ctephmentioning

confidence: 99%

After the Dawn　― Balloon Pulmonary Angioplasty for Patients With Chronic Thromboembolic Pulmonary Hypertension ―

Ogawa

Matsubara

2018

Circ J

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In the past 5 years, balloon pulmonary angioplasty (BPA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are deemed inoperable has undergone significant refinement. As a result, the procedure is now used worldwide and has become a promising therapeutic option for those patients. However, pulmonary endarterectomy remains the gold standard treatment for patients with CTEPH because the techniques and strategies for BPA are not yet unified. The best therapeutic option for each patient should be determined based on discussion among a multidisciplinary team of experts. For BPA to become an established treatment for CTEPH, further data are needed. This review summarizes the techniques and strategies of BPA at present and discusses the future development of the procedure.

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Pulmonary endarterectomy for distal chronic thromboembolic pulmonary hypertension

Cited by 116 publications

References 29 publications

Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension

Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension

Long-Term Outcome of Patients With Chronic Thromboembolic Pulmonary Hypertension

After the Dawn　― Balloon Pulmonary Angioplasty for Patients With Chronic Thromboembolic Pulmonary Hypertension ―

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Pulmonary endarterectomy for distal chronic thromboembolic pulmonary hypertension

Cited by 116 publications

References 29 publications

Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension

Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension

Long-Term Outcome of Patients With Chronic Thromboembolic Pulmonary Hypertension

After the Dawn ― Balloon Pulmonary Angioplasty for Patients With Chronic Thromboembolic Pulmonary Hypertension ―

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After the Dawn　― Balloon Pulmonary Angioplasty for Patients With Chronic Thromboembolic Pulmonary Hypertension ―