Pulmonary Endarterectomy: Recent Changes in a Single Institution's Experience of More Than 2,700 Patients

Madani, Michael M.; Auger, William R.; Pretorius, Victor; Sakakibara, Naohide; Kerr, Kim M.; Kim, Nick H.; Fedullo, Peter F.; Jamieson, Stuart W.

doi:10.1016/j.athoracsur.2012.04.004

Cited by 536 publications

(547 citation statements)

References 15 publications

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“…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%

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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“…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%

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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“…When the surgery was performed at an experienced center, there was a decline in perioperative mortality rates, and long-term pulmonary hemodynamic and functional status benefits were realized; as a result, the procedure was regarded as a potential cure for this form of pulmonary hypertension. [1][2][3] However, it has also become evident that there are identifiable CTEPH patients for whom PTE surgery is not an option-notably, those with technically inoperable chronic thromboembolic disease and those whose comorbidities preclude a reasonable expectation that surgery will have short-or long-term benefits. This observation was underscored in the results of the International Prospective CTEPH registry, where 36.6% of enrolled patients were deemed inoperable.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Chronic Thromboembolic Pulmonary Hypertension: The Role of Medical Therapy and Balloon Pulmonary Angioplasty

Fernandes

Poch

Auger

2016

Methodist DeBakey Cardiovascular Journal

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable disease when treated with pulmonary thromboendarterectomy (PTE). However, even at experienced surgical centers, nearly one-third of patients with CTEPH will be deemed inoperable for reasons including distal disease, comorbidities, or out-of-proportion pulmonary hypertension. It is in these patients with inoperable CTEPH that pulmonary hypertension (PH)-targeted medical therapy and balloon pulmonary angioplasty have potential therapeutic value.Previous unblinded cohort trials have assessed PH-targeted medical therapy in various subpopulations of CTEPH patients using epoprostenol, treprostinil, sildenafil, bosentan, and iloprost, each demonstrating measurable pulmonary hemodynamic effects. However, riociguat, a soluble guanylate cyclase stimulator, is the first FDA-approved therapy for inoperable CTEPH to demonstrate both an improvement in functional capabilities (6-minute walk time) as well as significant gains in secondary pulmonary hemodynamic end points in a large placebo-controlled trial.Balloon pulmonary angioplasty is an interventional procedure using telescoping catheters placed in the pulmonary arteries, through which wires and balloons are used to mechanically disrupt chronic clot material and relieve pulmonary vascular obstruction. Contemporary case series from multiple centers worldwide have demonstrated pulmonary hemodynamic improvement with this approach.As a result of these advances, patients with inoperable CTEPH who had few options as recently as 5 years ago now have alternatives with emerging evidence of therapeutic efficacy.

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“…В данной когорте пациентов отмечались тяжелые клинические проявления заболевания, высокие показатели систолического ДЛА и выраженные расстройства газообмена и гемодинамического статуса. Выживаемость у больных с массивной и субмассивной ТЭЛА была значительно ниже, чем у пациентов с сегментарным и субсегмен-тарным тромбозом [22][23][24].…”

Section: Discussionunclassified

Three-Year Results of Medical and Surgical Reperfusional Treatment of Patients Transposed by Thromboembolia of Pulmonary Artery: Outcome, Clinical Status, State of Pulmonary Perfusion

Тарасов¹,

Коков²,

Bezdenezhny³

et al. 2017

Kompleks. probl. serdečno-sosud. zabol.

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Pulmonary Endarterectomy: Recent Changes in a Single Institution's Experience of More Than 2,700 Patients

Cited by 536 publications

References 15 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

Treatment of Chronic Thromboembolic Pulmonary Hypertension: The Role of Medical Therapy and Balloon Pulmonary Angioplasty

Three-Year Results of Medical and Surgical Reperfusional Treatment of Patients Transposed by Thromboembolia of Pulmonary Artery: Outcome, Clinical Status, State of Pulmonary Perfusion

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