Long-term outcome after pulmonary endarterectomy.
BACKGROUND
There are few follow-up studies on long-term cardiopulmonary function after pulmonary endarterectomy (PEA), the operation of choice for chronic thromboembolic pulmonary hypertension (CTEPH).


OBJECTIVE
To prospectively evaluate long-term outcome of patients with CTEPH treated with PEA.


METHODS
Between 1994 and 2006, 157 patients (mean age 55 yr) were treated with PEA at Pavia University Hospital. The patients were evaluated before PEA and at 3 months (n = 132), 1 year (n = 110), 2 years (n = 86), 3 years (n = 69), and 4 years (n = 49) afterward by NYHA class, right heart hemodynamic, spirometry, carbon monoxide transfer factor (Tl(CO)), arterial blood gas, and treadmill incremental exercise test.


RESULTS
Cumulative survival was 84%. Within 3 months, 18 patients died in-hospital and 2 had lung transplantation; during long-term follow-up, 6 died, 1 had lung transplantation, and 3 had a second PEA (2.5 events per 100 person-years). NYHA class III-IV was the most important predictor of late death, lung transplant, or PEA redo (hazard ratio, 3.94). Extraordinary improvement in NYHA class, hemodynamic, and Pa(O(2)) were achieved in the first 3 months (P < 0.001) and persisted during follow-up; exercise tolerance progressively increased over time (P < 0.001). At 4 years, although 74% of the patients were in NYHA class I and none was in class IV, 24% had pulmonary vascular resistance greater than 500 dyne.s/cm(5) or Pa(O(2)) less than 60 mm Hg; they were significantly older and were more frequently in NYHA class III-IV 3 months after surgery than the others.


CONCLUSIONS
After PEA, long-term survival and cardiopulmonary function recovery is excellent in most patients.
Division of Respiratory Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy .
Angelo G
AG
Corsico
Andrea M
AM
D'Armini
Isa
I
Cerveri
Catherine
C
Klersy
Elena
E
Ansaldo
Rosanna
R
Niniano
Elena
E
Gatto
Cristian
C
Monterosso
Marco
M
Morsolini
Salvatore
S
Nicolardi
Corrado
C
Tramontin
Ernesto
E
Pozzi
Mario
M
Viganò
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002908:Chronic Disease; D004691:Endarterectomy; D005080:Exercise Test; D005260:Female; D005352:Fibromuscular Dysplasia / Q000601:surgery*; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000601:surgery*; D011653:Pulmonary Diffusing Capacity / Q000502:physiology; D011655:Pulmonary Embolism / Q000601:surgery*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D013147:Spirometry; D015996:Survival Rate; D014655:Vascular Resistance / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology
D010100:Oxygen