[Chronic thromboembolic pulmonary hypertension: surgical treatment with thromboendarterectomy].
OBJECTIVE
Pulmonary thromboendarterectomy (PTE) is considered the potential curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We analysed the results of the PTE application in our institution.


METHODS
From February 1996 to December 2007, 30 patients with CTEPH underwent video-assisted PTE. Preoperative hemodynamic data were: systolic pulmonary artery pressure (SPAP) 87+/-17mmHg, mean pulmonary artery pressure (MPAP) 51+/-11mmHg, pulmonary total resistance 1067+/-485dynes x s x cm(-5), pulmonary vascular resistance 873+/-389dynes x s x cm(-5) and cardiac index 2.2+/-0.5l/min/m(2). We analysed the influence of several factors on hospital mortality and survival, and we performed partial analysis of mortality since 2004.


RESULTS
PTE resulted in significant improvements in SPAP (P<0.001), MPAP (P=0.001) and cardiac index (P<0.001). Hospital mortality was 17% (5/30) (95% confidence interval, 6%-35%). From 2004, it dropped to 5% (1/20) (95% confidence interval, 0%-25%). Hospital mortality was influenced by preoperative pulmonary total resistance, preoperative pulmonary vascular resistance, postoperative SPAP, reduction of SPAP, reduction of MPAP, reperfusion pulmonary oedema and residual postoperative pulmonary hypertension (P=0.036; P=0.018;P=0.013; P=0.050; P=0.050; P=0.030; P=0.045). Survival after PTE, including hospital mortality, was 76+/-9% at 10 years. Through long-term follow-up, functional status (P=0.001), 6min walking distance (P=0.001), end-diastolic right ventricle size (P<0.001), and tricuspid regurgitation (P<0.001) significantly improved.


CONCLUSIONS
PTE effectively reduces pulmonary hypertension and offers CTEPH patients a substantial improvement in survival and quality of life.
Blázquez
José Antonio
JA
Servicio de Cirugía Cardíaca, Hospital Universitario 12 de Octubre, Madrid, España. blazquezmd@hotmail.com
Escribano
Pilar
P
Pérez
Enrique
E
López
María Jesús
MJ
Gómez
Miguel Angel
MA
Cortina
José María
JM
D000328:Adult; D000368:Aged; D002302:Cardiac Output; D002908:Chronic Disease; D004691:Endarterectomy / Q000379:methods*; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D017380:Hypertrophy, Right Ventricular / Q000209:etiology / Q000473:pathology; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011654:Pulmonary Edema / Q000209:etiology; D011655:Pulmonary Embolism / Q000150:complications / Q000601:surgery*; D015427:Reperfusion Injury / Q000209:etiology; D012189:Retrospective Studies; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000503:physiopathology; D014655:Vascular Resistance; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000503:physiopathology; D020535:Video-Assisted Surgery