title: Pulmonary endarterectomy in severe chronic thromboembolic pulmonary hypertension.
abstract: BACKGROUND
  The outcome of patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary endarterectomy (PEA) after urgent hospitalization for decompensated right heart failure (DRHF) remains unclear.
  
  
  METHODS
  Among 120 consecutive patients undergoing PEA, 16 (13%) presented with a history of urgent hospitalization for DRHF (severe RHF group). This group was compared with the remaining 104 patients presenting with total peripheral vascular resistance (TPR) < 1,200 dynes · sec · cm(-5) (n = 78, control group) and >1,200 dynes · sec · cm(-5) (n = 26, high TPR group).
  
  
  RESULTS
  DRHF occurred predominantly in patients with TPR > 1,200 dynes · sec · cm(-5) (prevalence of 32% vs 5% in patients with TPR < 1,200 dynes · sec · cm(-5), p < 0.0001). The overall in-hospital mortality after PEA was 4% (n = 5). All deaths occurred in patients with TPR > 1,200 dynes · sec · cm(-5) and DRHF. The proportion of patients with residual PH immediately after surgery was higher in the high TPR group (50%) and severe RHF group (56%) compared with the control group (29%; p = 0.04). In multivariate analysis, risk factors for residual PH after surgery were TPR > 1,200 dynes · sec · cm(-5), Jamieson disease Type III-IV, and female gender. A history of DRHF by itself was not a risk factor for residual PH after PEA. The overall 5-year survival was 87%. After a median follow-up of 20 months, the proportion of patients receiving medical therapy for residual PH was higher in patients with post-operative mean pulmonary artery pressure ≥35 mm Hg (61% vs 9%, p = 0.0007).
  
  
  CONCLUSIONS
  DRHF occurs more frequently in patients with TPR > 1,200 dynes · sec · cm(-5), increasing the operative risk in these patients. The outcome of patients with high TPR in the absence of DRHF is excellent. However, patients with residual mean pulmonary artery pressure ≥35 mm Hg frequently receive pulmonary hypertension therapy after PEA.
authors.affiliation: Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: marc.deperrot@uhn.on.ca.
authors.forename: Marc
authors.initials: M
authors.lastname: de Perrot
authors.affiliation: Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Thenganatt
authors.affiliation: Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: McRae
authors.affiliation: Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jakov
authors.initials: J
authors.lastname: Moric
authors.affiliation: Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Olaf
authors.initials: O
authors.lastname: Mercier
authors.affiliation: Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Pierre
authors.affiliation: Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Susanna
authors.initials: S
authors.lastname: Mak
authors.affiliation: Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Granton
mesh_terms: D006328:Cardiac Catheterization; D002908:Chronic Disease; D004452:Echocardiography; D004691:Endarterectomy / Q000379:methods*; D005500:Follow-Up Studies; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D009864:Ontario / Q000453:epidemiology; D011651:Pulmonary Artery / Q000601:surgery*; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends
keywords: decompensated right heart failure; outcome; pulmonary endarterectomy; thromboembolic pulmonary hypertension; total peripheral vascular resistance