Pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension: hemodynamic characteristics and changes✩

D’Armini, Andrea Maria; Cattadori, Barbara; Monterosso, Cristian; Klersy, Catherine; Emmi, V.; Piovella, Franco; Minzioni, Gaetano; Viganò, Mario

doi:10.1016/s1010-7940(00)00584-4

Cited by 89 publications

(66 citation statements)

References 18 publications

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“…Thus, therapeutic strategies for management of RV contractile failure have concentrated on maneuvers to reduce RV afterload, such as pulmonary thromboendarterectomy or fibrinolysis in pulmonary embolism [6,7], inhaled nitric oxide following cardiopulmonary bypass or cardiac transplant [4], and on use of positive inotropic agents such as dobutamine. While there is no question that global RV ejection fraction sometimes improves with such therapeutic interventions, response to these interventions is highly variable.…”

Section: Introductionmentioning

confidence: 99%

Calpain inhibition attenuates right ventricular contractile dysfunction after acute pressure overload

Greyson

Schwartz

et al. 2008

Journal of Molecular and Cellular Cardiology

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Objective-Right ventricular contractile failure from acute RV pressure overload is an important cause of morbidity and mortality, but the mechanism of RV failure in this setting is incompletely defined. We hypothesized that RV dysfunction from acute RV pressure overload is in part due to activation of calpain, and that calpain inhibition would therefore attenuate RV dysfunction.Methods-Anesthetized, open chest pigs were treated with the calpain inhibitor MDL-28170 or with inactive vehicle, and then subjected to acute RV pressure overload for 90 min. RV contractile function was assessed by the regional Frank-Starling relation. RV myocardial tissue was analyzed for evidence of calpain activation and calpain-mediated proteolysis.Results-RV pressure overload caused severe contractile dysfunction, along with significant alterations in the endogenous calpain inhibitor calpastatin typical of calpain activation. MDL-28170 attenuated RV free wall dysfunction by more than 50%. However, there were no differences in degradation of spectrin, desmin, troponin-I or SERCA2 between SHAM operated pigs and pigs subjected to acute RV pressure overload, or between vehicle and MDL-28170 treated pigs.Conclusions-Acute RV pressure overload causes calpain activation, and RV contractile dysfunction from acute RV pressure overload is attenuated by the calpain inhibitor MDL-28170; however, the effect is not explained by inhibition of calpain-mediated degradation of spectrin, desmin, troponin-I or SERCA2. Since this is the first report of any agent that can directly attenuate RV contractile dysfunction in acute RV pressure overload, further investigation of the mechanism of action of MDL-28170 in this setting is warranted.

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Section: Introductionmentioning

confidence: 99%

Calpain inhibition attenuates right ventricular contractile dysfunction after acute pressure overload

Greyson

Schwartz

et al. 2008

Journal of Molecular and Cellular Cardiology

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“…The gold standard treatment of choice is pulmonary endarterectomy (PEA) surgery. Distal disease, whether vasculopathic or small vessel thrombotic, is a major risk factor for poorer outcome [1][2][3]. It has, however, been demonstrated that patients with high pulmonary vascular resistance (PVR) can still potentially benefit from operative intervention.…”

mentioning

confidence: 99%

Occlusion pressure analysis role in partitioning of pulmonary vascular resistance in CTEPH

Toshner¹,

Suntharalingam²,

Fesler³

et al. 2012

Eur Respir J

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Flow-directed pulmonary artery occlusion is posited to enable partitioning of vascular resistance into small and large vessels. As such it may have a role in assessment for pulmonary endarterectomy.To test if the occlusion technique distinguished small from large vessel disease we studied 59 subjects with chronic thromboembolic pulmonary hypertension (CTEPH), idiopathic pulmonary arterial hypertension (IPAH), and connective tissue disease (CTD)-associated PAH. At right heart catheterisation, occlusion pressures were recorded. With fitting of the pressure decay curve, pulmonary vascular resistance was partitioned into downstream (small vessels) and upstream (large vessels, Rup).47 patients completed the study; 14 operable CTEPH, 15 inoperable CTEPH, 13 idiopathic or CTD-PAH and five post-operative CTEPH. There was a significant difference in mean Rup in the proximal operable CTEPH group 87.3 (95% CI 84.1-90.5); inoperable CTEPH mean 75.8 (95% CI 66.76-84.73), p50.048; and IPAH/CTD, mean 77.1 (95% CI 71.86-82.33), p50.003. Receiver operating characteristic curves to distinguish operable from inoperable CTEPH demonstrated an area under the curve of 0.75, p50.0001. A cut-off of 79.3 gave 100% sensitivity (95% CI 73.5-100%) but 57.1% specificity (95% CI 28.9-82.3%). In a subgroup analysis of multiple lobar sampling there was demonstrable heterogeneity.Rup is significantly increased in operable proximal CTEPH compared with non-operable distal CTEPH and IPAH/CTD-PAH. Rup variability in patients with CTEPH and PAH is suggestive of pathophysiological heterogeneity.

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“…Similarly, in a large series of 500 patients with CTEPH who underwent PEA, Jamieson et al reported that patients with a preoperative PVR of >1000 dyne·s·cm-5 had a significantly higher mortality rate than did those with a preoperative PVR of <1000 dyne·s·cm-5 (10.1% vs. 1.4%, respectively; P<0.0001) [18,19]. Although D' Armini et al reported that PEA leads to hemodynamic recovery even in severely compromised patients with CTEPH; the balance of evidence indicates that a high preoperative PVR has an unfavorable effect on the outcome after PEA [20].…”

Section: Discussionmentioning

confidence: 99%

Ratio of Pulmonary Vascular Resistance to Occluded Pulmonary Segments as an Indicator of Operability of Chronic Thromboembolic Pulmonary Hypertension Lesions

Huili¹,

Zhang²,

Ling³

2017

J Hematol Thrombo Dis

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Objective: The operability evaluation for pulmonary thromboendarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is always difficult. In this study, we aimed to identify a better indicator of operability in patients with surgically accessible CTEPH lesions.Methods: Two-hundred-eight patients with surgically accessible CTEPH lesions who underwent PEA at Beijing Anzhen Hospital from March 2001 to February 2014 were retrospectively reviewed. The occluded pulmonary segments (OPS) were assessed by ventilation/perfusion scintigraphy, pulmonary vascular resistance (PVR) was measured by right heart catheterization and the PVR/OPS ratio was calculated.Results: Seven (3.37%) early deaths occurred in the post-PEA period, six late deaths occurred during the mean follow-up period of 58.3 ± 39.7 months; the 5 year actuarial survival rate was 95.1% ± 3.5%. The PVR/OPS ratios of early and late death after PEA were significantly higher than those of early and late survival, respectively. A PVR/OPS ratio of <100 dyne·s·cm-5/OPS had much better specificity (88.7% vs. 69.2%) and sensitivity (92.3% vs. 38.5%) than did PVR alone in the prediction of early and late survival. The difference between the two areas under their receiver operating characteristic curves reached statistical significance (z test: Z=1.9917, P=0.046). Conclusion:The PVR/OPS ratio is a better indicator of operability for surgically accessible CTEPH than is PVR alone. Patients with a PVR/OPS ratio of <100 dyne·s·cm-5/OPS have better early and long-term outcomes after PEA.

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Pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension: hemodynamic characteristics and changes✩

Abstract: None of the variables considered was correlated with early death or functional nonsuccess. Neither preoperative severity of pulmonary hypertension nor degree of cardiac failure influenced the outcome of the operation. PTE leads to hemodynamic recovery even in very compromised patients.

Cited by 89 publications

References 18 publications

Calpain inhibition attenuates right ventricular contractile dysfunction after acute pressure overload

Calpain inhibition attenuates right ventricular contractile dysfunction after acute pressure overload

Occlusion pressure analysis role in partitioning of pulmonary vascular resistance in CTEPH

Ratio of Pulmonary Vascular Resistance to Occluded Pulmonary Segments as an Indicator of Operability of Chronic Thromboembolic Pulmonary Hypertension Lesions

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