title: Mid-term results of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.
abstract: BACKGROUND
  In patients with chronic thromboembolic pulmonary hypertension, acute and striking decreases of pulmonary artery pressures and vascular resistance can be achieved by pulmonary thromboendarterectomy. In this study, the long-term effects of pulmonary thromboendarterectomy on hemodynamic indices and right ventricular function were investigated.
  
  
  METHODS
  Sixty-five patients (31 women and 34 men; mean age, 47 +/- 17 years; range, 19 to 69 years; New York Heart Association [NYHA] functional class II, n = 3; class III, n = 38; class IV, n = 24) were reassessed 13 to 48 months (mean, 27 months) after pulmonary thromboendarterectomy. Measurements are reported as mean +/- standard deviation.
  
  
  RESULTS
  All patients reported a significant improvement of symptoms: 46 patients were in NYHA functional class I, 16 patients in class II, and 3 patients in class III. Mean pulmonary vascular resistance was significantly reduced compared with preoperative and postoperative values (preoperative: 1,015 +/- 454 dynes.s.cm-5; postoperative: 322 +/- 154 dynes.s.cm-5; follow-up: 198 +/- 72 dynes.s.cm-5; p < 0.001 versus preoperative; p < 0.025 versus postoperative). Concomitantly, cardiac index was significantly increased compared with preoperative values (preoperative: 2.0 +/- 0.7 L.min-1.m-2; follow-up: 2.9 +/- 0.5 L.min-1.m-2; p < 0.001). Significant reductions of right ventricular dimensions and recovery of right ventricular function could be demonstrated radiologically and echocardiographically. In 3 patients (preoperative NYHA class IV, NYHA class III at follow-up) with proven coagulation abnormalities, pulmonary vascular resistance was moderately increased at follow-up compared with postoperative measurements.
  
  
  CONCLUSIONS
  In patients with chronic thromboembolic pulmonary hypertension, a persistent decrease of pulmonary vascular resistance and improvement of right ventricular function and NYHA functional status can be achieved by pulmonary thromboendarterectomy.
authors.affiliation: Department for Cardiothoracic, Johannes Gutenberg-University Hospital Mainz, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Mayer
authors.forename: M
authors.initials: M
authors.lastname: Dahm
authors.forename: U
authors.initials: U
authors.lastname: Hake
authors.forename: F X
authors.initials: FX
authors.lastname: Schmid
authors.forename: M
authors.initials: M
authors.lastname: Pitton
authors.forename: I
authors.initials: I
authors.lastname: Kupferwasser
authors.forename: S
authors.initials: S
authors.lastname: Iversen
authors.forename: H
authors.initials: H
authors.lastname: Oelert
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001778:Blood Coagulation Disorders / Q000150:complications / Q000503:physiopathology; D002302:Cardiac Output; D002407:Catheterization, Swan-Ganz; D002908:Chronic Disease; D004452:Echocardiography; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011669:Pulmonary Wedge Pressure; D017131:Thrombectomy; D013923:Thromboembolism / Q000150:complications; D014655:Vascular Resistance; D016278:Ventricular Function, Right