The actuarial survival analysis of the surgical and non-surgical therapy regimen for chronic thromboembolic pulmonary hypertension.
OBJECTIVE
To characterize the in-hospital mortality and the actuarial survival of surgical and non-surgical therapy regimen in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH).


METHODS
A retrospective cohort study was conducted in 504 patients with CTEPH, who were treated surgically (n = 360), or non-surgically (n = 144) in Anzhen Hospital from February 1989 to August 2007. The patients in surgical group received a standard pulmonary thromboendarterectomy (PTE), while those in non-surgical group were given thrombolytic therapy. The actuarial survival of the two groups was determined with the Kaplan-Meier survival curves. Univariate analysis and multivariate binary logistic regression and Cox proportional hazard analysis were used to identify the risk factors for the in-hospital and late deaths.


RESULTS
The in-hospital mortality for the surgical group and non-surgical group were 4.44% and 3.50%, respectively. For the proximal type of CTEPH, the actuarial survival at 10 and 15 years of the surgical group and non-surgical group were 94.60 +/- 2.38%, 90.96 +/- 4.24% and 81.4 +/- 7.14%, 56.43 +/- 14.7%, respectively (chi(2) = 12.33, P = 0.0004). For the distal type of CTEPH, the actuarial survival at 10 and 15 years of the surgical group and non-surgical group were 71.78 +/- 4.66%, 29.57 +/- 15.1% and 69.84 +/- 7.78%, 32.59 +/- 13.7%, respectively (chi(2) = 0.03, P = 0.874).


CONCLUSIONS
The PTE procedure has statistically superiority over thrombolytic therapy for the proximal type of CTEPH in terms of actuarial survival; however, for the distal type of CTEPH, the PTE procedure provides no benefits with regard to actuarial survival.
Gan
Hui-Li
HL
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University (BAZH-CMU), Beijing Institute of Heart, Lung and Vessel Disease, Beijing, 100029, China. ganhuili@hotmail.com
Zhang
Jian-Qun
JQ
Bo
Ping
P
Zhou
Qi-Wen
QW
Wang
Sheng-Xun
SX
D000328:Adult; D002681:China / Q000453:epidemiology; D004691:Endarterectomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015912:Thrombolytic Therapy