title: Pulmonary oligemia maneuver can alleviate pulmonary artery injury during pulmonary thromboendarterectomy procedure.
abstract: BACKGROUND
  Pulmonary thromboendarterectomy (PTE) has evolved as a treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to characterize if pulmonary oligemia maneuver (POM) can alleviate pulmonary artery injury during PTE procedure.
  
  
  METHODS
  A total of 112 cases of CTEPH admitted to Beijing Anzhen Hospital from March 2002 to August 2011 received PTE procedure. They were retrospectively classified as non-POM group (group A, n = 55) or POM group (group B, n = 57). Members from group B received POM during rewarming period, whereas members from group A did not.
  
  
  RESULTS
  There were three (5.45%) early deaths in group A, no death in group B (0) (Fisher's exact test, P = 0.118). Six patients in group A needed extracorporeal membrane oxygenation (ECMO) as life support after the PTE procedure, no patients in group B needed ECMO (Fisher's exact test, P = 0.013). The patients in group B had a shorter intubation and ICU stay, lower mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR), higher partial pressure of oxygen in artery (PaO2) and arterial oxygen saturation (SaO2) and less medical expenditure than patients in group A. With a mean follow-up time of (58.3 ± 30.6) months, two patients in group A and one patient in group B died. The difference of the actuarial survival after the procedure between the two groups did not reach statistical significance. Three months post the PTE procedure, the difference of residual occluded pulmonary segment between the two groups did not reach statistical significance (P = 0.393).
  
  
  CONCLUSIONS
  POM can alleviate pulmonary artery injury, shorten ICU stay and intubation time, and lower down the rate of ECMO after PTE procedure.
authors.affiliation: Cardiac Surgery Department, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing 100029, China. ganhuili@hotmail.com
authors.forename: Hui-li
authors.initials: HL
authors.lastname: Gan
authors.forename: Jian-qun
authors.initials: JQ
authors.lastname: Zhang
authors.forename: Jia-kai
authors.initials: JK
authors.lastname: Lu
authors.forename: Xiu-hua
authors.initials: XH
authors.lastname: Dong
authors.forename: Xiao-tong
authors.initials: XT
authors.lastname: Hou
authors.forename: Yuan-ming
authors.initials: YM
authors.lastname: Gao
authors.forename: Guang-fa
authors.initials: GF
authors.lastname: Zhu
mesh_terms: D000328:Adult; D004691:Endarterectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000293:injuries*; D012189:Retrospective Studies