title: Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry.
abstract: OBJECTIVE
  Pulmonary endarterectomy is a curative surgical treatment option for the majority of patients with chronic thromboembolic pulmonary hypertension. The current surgical management and postoperative outcome of patients enrolled in an international registry on chronic thromboembolic pulmonary hypertension were investigated.
  
  
  METHODS
  The registry included newly diagnosed (≤6 months) consecutive patients with chronic thromboembolic pulmonary hypertension from February 2007 to January 2009.
  
  
  RESULTS
  A total of 679 patients were registered from 1 Canadian and 26 European centers, of whom 386 (56.8%) underwent surgery. The median age of patients undergoing surgery was 60 years, and 54.1% were male. Previous pulmonary embolism was confirmed for 79.8% of patients. Perioperative complications occurred in 189 patients (49.2%): infection (18.8%), persistent pulmonary hypertension (16.7%), neurologic (11.2%) or bleeding (10.2%) complications, pulmonary reperfusion edema (9.6%), pericardial effusion (8.3%), need for extracorporeal membrane oxygenation (3.1%), and in-hospital mortality due to perioperative complications (4.7%). Documented 1-year mortality was 7%. Preoperative exercise capacity was predictive of 1-year mortality. Postoperative pulmonary vascular resistance predicted in-hospital and 1-year mortality. In patients evaluated within 1 year after surgery, the median pulmonary vascular resistance had decreased from 698 to 235 dyn x s x cm(-5) (95% confidence limit, 640-874 and 211-255, respectively, n = 70) and the median 6-minute walk distance had increased from 362 to 459 m (95% confidence limit, 340-399 and 440-473, respectively, n = 168). New York Heart Association functional class improved with most patients progressing from class III/IV to class I/II.
  
  
  CONCLUSIONS
  Pulmonary endarterectomy is associated with a low in-hospital mortality rate and improvements in hemodynamics and exercise capacity.
authors.affiliation: Kerckhoff Heart and Lung Center, Bad Nauheim, Germany. emayer@kkmainz.de
authors.forename: Eckhard
authors.initials: E
authors.lastname: Mayer
authors.forename: David
authors.initials: D
authors.lastname: Jenkins
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Lindner
authors.forename: Andrea
authors.initials: A
authors.lastname: D'Armini
authors.forename: Jaap
authors.initials: J
authors.lastname: Kloek
authors.forename: Bart
authors.initials: B
authors.lastname: Meyns
authors.forename: Lars Bo
authors.initials: LB
authors.lastname: Ilkjaer
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
authors.forename: Marion
authors.initials: M
authors.lastname: Delcroix
authors.forename: Irene
authors.initials: I
authors.lastname: Lang
authors.forename: Joanna
authors.initials: J
authors.lastname: Pepke-Zaba
authors.forename: Gerald
authors.initials: G
authors.lastname: Simonneau
authors.forename: Philippe
authors.initials: P
authors.lastname: Dartevelle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D016009:Chi-Square Distribution; D002908:Chronic Disease; D002983:Clinical Competence; D004691:Endarterectomy / Q000009:adverse effects / Q000401:mortality; D005060:Europe; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D020127:Recovery of Function; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013923:Thromboembolism / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance; D055815:Young Adult