title: Medical and surgical management for chronic thromboembolic pulmonary hypertension: a single center experience.
abstract: BACKGROUND
  Pulmonary endarterectomy (PE) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to analyze our experience in the medical and surgical management of CTEPH.
  
  
  METHODS
  We included 80 patients diagnosed with CTEPH between January 2000 and July 2012. Thirty two patients underwent PE and 48 received medical treatment (MT). We analyzed functional class (FC), six-minute walking distance (6MWD) and pulmonary hemodynamics. Mortality in both groups and periods were analyzed.
  
  
  RESULTS
  Patients who underwent PE were younger, mostly men, and had longer 6MWD. No differences were observed in pulmonary hemodynamics or FC at diagnosis. One year after treatment, all PE patients versus 41% in MT group were at FCI-II. At follow-up, the PE group showed greater increase in 6MWD, and greater reduction in mean pulmonary arterial pressure and pulmonary vascular resistance than the MT group (P<.05). Overall survival in the MT group at 1 and 5years was 83% and 69%, respectively. Conditional survival in patients alive 100days post-PE at 1 and 5years was 95% and 88%, respectively. Surgical mortality in operated patients in the first period (2000-2006) was 31,3%, and 6,3% in the second (2007-2012).
  
  
  CONCLUSIONS
  PE provides good clinical results, and improves pulmonary hemodynamics in patients who successfully overcome the immediate postoperative period. After a learning period, the current operatory mortality in our center is similar to international standards.
authors: Servicio de Neumología y Alergia Respiratoria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España; División de Insuficiencia Cardíaca e Hipertensión Pulmonar, Instituto de Cardiología de Corrientes, Corrientes, Argentina.
authors: María Lorena
authors: ML
authors: Coronel
authors: Servicio de Neumología y Alergia Respiratoria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España.
authors: Núria
authors: N
authors: Chamorro
authors: Servicio de Neumología y Alergia Respiratoria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, España.
authors: Isabel
authors: I
authors: Blanco
authors: Servicio de Neumología y Alergia Respiratoria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España.
authors: Verónica
authors: V
authors: Amado
authors: Servicio de Neumología y Alergia Respiratoria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España.
authors: Roberto
authors: R
authors: Del Pozo
authors: Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, España; Servicio de Cirugía Cardiovascular, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España.
authors: José Luis
authors: JL
authors: Pomar
authors: Servicio de Neumología y Alergia Respiratoria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, España.
authors: Joan Ramón
authors: JR
authors: Badia
authors: Servicio de Anestesiología y Reanimación, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
authors: Irene
authors: I
authors: Rovira
authors: Servicio de Anestesiología y Reanimación, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
authors: Purificación
authors: P
authors: Matute
authors: Servicio de Neumología y Alergia Respiratoria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España.
authors: Gemma
authors: G
authors: Argemí
authors: Servicio de Cirugía Cardiovascular, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España.
authors: Manuel
authors: M
authors: Castellà
authors: Servicio de Neumología y Alergia Respiratoria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, España. Electronic address: jbarbera@clinic.ub.es.
authors: Joan Albert
authors: JA
authors: Barberà
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002908:Chronic Disease; D003131:Combined Modality Therapy; D019468:Disease Management; D004691:Endarterectomy / Q000401:mortality; D065128:Endothelin Receptor Antagonists / Q000627:therapeutic use; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011453:Prostaglandins / Q000627:therapeutic use; D011652:Pulmonary Circulation; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome; D014655:Vascular Resistance; D016306:Vena Cava Filters
chemical_list: D002121:Calcium Channel Blockers; D065128:Endothelin Receptor Antagonists; D010726:Phosphodiesterase Inhibitors; D011453:Prostaglandins
keywords: Chronic thromboembolic pulmonary hypertension; Circulación pulmonar; Endarterectomía pulmonar; Hemodinámica pulmonar; Hipertensión pulmonar; Hipertensión pulmonar tromboembólica crónica; Pulmonary circulation; Pulmonary endarterectomy; Pulmonary hemodynamics; Pulmonary hypertension