Pulmonary hypertensive medical therapy in chronic thromboembolic pulmonary hypertension before pulmonary thromboendarterectomy.
BACKGROUND
The currently recommended treatment for chronic thromboembolic pulmonary hypertension is pulmonary thromboendarterectomy (PTE). No convincing evidence for the use of pulmonary hypertensive medical therapy (PHT) exists in operable candidates. We sought to determine the prevalence of the use of PHT on referral for PTE and the effects on pre-PTE hemodynamics and post-PTE outcomes/hemodynamics.


RESULTS
We performed a retrospective analysis of chronic thromboembolic pulmonary hypertension patients referred for PTE during 2005-2007. The prevalence of PHT was determined for all patients referred to our institution. Hemodynamic and outcomes analysis involved only those undergoing PTE. Data included baseline demographics, PHT medication(s), dosage, duration of therapy, and time to referral. Hemodynamic data were acquired from the time of diagnosis, the time of referral visit, and after PTE. Outcomes included intensive care unit, hospital, and ventilator days; bleeding and infection rates; incidence of reperfusion lung injury; and in-hospital mortality. The control group (n=244) was compared with the PHT group (n=111); subgroups included monotherapy with bosentan, sildenafil, or epoprostenol and combination therapy. The prevalence of PHT significantly increased from 19.9% in 2005 to 37% in 2007. There was minimal benefit of treatment with PHT on pre-PTE mean pulmonary artery pressure, but its use was associated with a significant delay in time to referral for PTE. Both groups experienced significant improvements in hemodynamic parameters after PTE. The 2 groups did not differ significantly in any post-PTE outcome. Similar results were obtained for each subgroup.


CONCLUSIONS
Our results suggest that PHT use has minimal effect on pre-PTE hemodynamics and no effect on post-PTE outcomes/hemodynamics.
Jensen
Kurt W
KW
Division of Pulmonary Critical Care Medicine, University of California at San Diego, 9300 Campus Point Dr, La Jolla, CA 92037, USA.
Kerr
Kim M
KM
Fedullo
Peter F
PF
Kim
Nick Hyong
NH
Test
Victor J
VJ
Ben-Yehuda
Ori
O
Auger
William R
WR
D000959:Antihypertensive Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004691:Endarterectomy / Q000401:mortality* / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D015994:Incidence; D015995:Prevalence; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D011669:Pulmonary Wedge Pressure; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015427:Reperfusion Injury / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000627:therapeutic use
D000959:Antihypertensive Agents; D004232:Diuretics; D014665:Vasodilator Agents