Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension

Lankeit, Mareike; Krieg, Valentin J.; Hobohm, Lukas; Kölmel, Sebastian; Liebetrau, Christoph; Konstantinides, Stavros; Hamm, Christian W.; Mayer, Eckhard; Wiedenroth, Christoph B.; Guth, Stefan

doi:10.1016/j.healun.2017.06.011

Cited by 41 publications

(48 citation statements)

References 27 publications

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“…The optimal treatment for CTED patients is still a matter of debate [9,10]. After pulmonary embolism there is a continuum of symptoms, ranging from patients with "only" detectable perfusion defects (∼30-50%) [28,29] to very ill patients with severe CTEPH [6,[30][31][32]. The rationale for offering PEA is that the pathophysiology leading to exercise limitation in CTED is comparable to that in CTEPH.…”

Section: Discussionmentioning

confidence: 99%

Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease

et al. 2018

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Symptomatic patients with chronic thromboembolic disease (CTED) without pulmonary hypertension often show an excessive increase in mean pulmonary arterial pressure (MPAP) during exercise.We report on the impact of pulmonary endarterectomy (PEA) on pulmonary haemodynamics in a prospective series of 32 consecutive CTED patients who underwent PEA. All patients had a comprehensive diagnostic work-up including right heart catheterisation at baseline and 12 months after PEA. Furthermore, in 12 patients exercise right heart catheterisation was performed before and after PEA.After PEA, MPAP was lower at rest (20±3 17±3 mmHg; p=0.008) and during maximal exercise (39±8 31±6 mmHg; p=0.016). The mean total pulmonary resistance (TPR) decreased from 3.6±0.8 Wood Units (WU) pre-operatively to 2.7±0.7 WU 1 year after PEA (p=0.004) and the mean slope of the MPAP/cardiac output (CO) relationship decreased from 3.6±1.0 to 2.3±0.8 WU (p=0.002). Peak oxygen uptake increased from 1.2±0.4 to 1.5±0.3 L·min (p=0.014) and ventilatory equivalents of carbon dioxide decreased from 39±2 to 30±2 (p=0.002). There was a significant improvement in quality of life assessed by the Cambridge Pulmonary Hypertension Outcome Review questionnaire.In CTED patients, PEA resulted in haemodynamic and clinical improvements. The means of TPR and MPAP/CO slopes decreased to <3.0 WU.

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Section: Discussionmentioning

confidence: 99%

Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease

et al. 2018

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“…Diagnosis of CTEPH was confirmed based on current guideline recommendations [2]. The study protocol and clinical data of the study cohort have been reported previously [17]. Briefly, information on comorbidities, risk factors for CTEPH, medication, results from clinical tests such as RHC, transthoracic echocardiography (TTE), 6-minute walk test (6MWT) and laboratory measurements, surgical procedure and in-hospital course were collected using a standardized case report form.…”

Section: Patient Cohortmentioning

confidence: 99%

“…Between January 2014 and December 2015, 258 patients underwent PEA at a national reference centre, as described previously [17]. Overall, 30 patients (11.6%) met the exclusion criteria (Fig.…”

Section: Patient Cohortmentioning

confidence: 99%

Risk factors for chronic thromboembolic pulmonary hypertension – Importance of thyroid disease and function

Krieg

Hobohm

Liebetrau

et al. 2020

Thrombosis Research

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Introduction: Although a number of risk factors for chronic thromboembolic pulmonary hypertension (CTEPH) have been reported, the exact prevalence is controversial and varies between published cohorts. The aim of the present study was to investigate the prevalence of risk factors in operable CTEPH patients with special emphasis on thyroid disease and function. Material and methods: Overall, 228 CTEPH patients (47.7% female; median age 63 [IQR 52-72] years) scheduled for pulmonary endarterectomy between 01/2014 and 12/2015 were studied. Prevalence of risk factors was assessed, and patients were classified according to their thyroid function based on laboratory measurements. Results: As many as 86.0% of patients reported a history of pulmonary embolism (PE; of those, 24.5% were diagnosed with "acute" PE less than six months before the diagnosis of CTEPH), 80.7% of patients had a blood group non-0 and 24.1% of patients had known thyroid disease (of those, 78.2% hypothyroidism). Laboratory measurements revealed thyroid dysfunction in 10.5% of patients (of those, 54.8% had no known thyroid disease). Patients with hypothyroid function had higher WHO functional classes, NT-proBNP levels and a lower cardiac index compared to patients with euthyroid function. Conclusions: The prevalence of a history of PE and blood group non-0 was higher than previously reported. However, a relevant proportion of patients might have suffered from pre-existing CTEPH rather than acute PE. Thyroid disease and dysfunction were frequent and hypothyroid function associated with more severe disease.

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“…Patients with CTEPH who had undergone PEA in the department of thoracic surgery in the Kerckhoff Clinic Bad Nauheim, Germany [13], from January 2010 until January 2012 were transferred and prospectively and consecutively assigned to an in-hospital start of an early rehabilitation program in the rehabilitation clinic Koenigstuhl Heidelberg, Germany. Patients were clinically examined before PEA, including right heart catheterisation at the Kerckhoff Clinic.…”

Section: Methodsmentioning

confidence: 99%

Supervised Exercise Training in Patients with Chronic Thromboembolic Pulmonary Hypertension as Early Follow-Up Treatment after Pulmonary Endarterectomy: A Prospective Cohort Study

et al. 2020

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Background: Data on exercise training in chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary endarterectomy (PEA) as well as data on clinical and haemodynamic changes shortly after PEA are lacking. Objective: The objective of this prospective study was to analyse the safety, feasibility, and the effectiveness of combined supervised inpatient rehabilitation in patients with CTEPH directly after PEA. Methods: CTEPH patients started a 19-week rehabilitation program (3 weeks as inpatients and continued at home for another 16 weeks) with supervised exercise training as follow-up treatment shortly after PEA. Haemodynamics were assessed by right heart catheterisation before PEA and 22 weeks after PEA. Non-invasive assessments as trans-thoracic echocardiography and 6-min walking distance (6MWD) were performed before PEA and after 3 (that is, beginning of rehabilitation), 6, and 22 weeks following PEA. Adverse events were recorded throughout the study. Results: Forty-five CTEPH patients were included (49% female, 57.6 ± 12.4 years old, 60% WHO functional class III). Rehabilitation was started 3.3 ± 0.9 weeks after PEA. Exercise training was well tolerated in all patients without severe side effects. Haemodynamics measured by right heart catheterisation significantly improved from pre-PEA to 22 weeks post-PEA in cardiac output (+1.2 ± 1.5 L/min, 33.4%, p = 0.001) and mean pulmonary arterial pressure (-19 ± 13 mm Hg,-39.6%, p < 0.0001). Right heart size measured by echocardiography, 6MWD, quality of life, and oxygen saturation significantly improved not only within the first 3 weeks after PEA but also during the following 19 weeks of exercise training. Conclusions: Supervised exercise training was feasible as early follow-up treatment after PEA. Further controlled studies are needed to discriminate the effects of PEA and early followup rehabilitation. Trial Registration: The study was regis-Nagel et al.

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Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension

Cited by 41 publications

References 27 publications

Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease

Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease

Risk factors for chronic thromboembolic pulmonary hypertension – Importance of thyroid disease and function

Supervised Exercise Training in Patients with Chronic Thromboembolic Pulmonary Hypertension as Early Follow-Up Treatment after Pulmonary Endarterectomy: A Prospective Cohort Study

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