title: Pulmonary endarterectomy outputs in chronic thromboembolic pulmonary hypertension.
abstract: OBJECTIVE
  Pulmonary thromboendarterectomy surgery is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension; extremely high pulmonary vascular resistance constitutes a risk factor for hospital mortality. The objective of this study was to analyze the immediate and long-term results of the surgical treatment of chronic thromboembolic pulmonary hypertension in patients with very severe pulmonary hypertension.
  
  
  METHODS
  Since February 1996, we performed 160 pulmonary thromboendarterectomies. We divided the patient population in 2 groups: group 1, which included 40 patients with pulmonary vascular resistance≥1090dyn/sec/cm-5, and group 2, which included the remaining 120 patients.
  
  
  RESULTS
  Hospital mortality (15 vs. 2.5%), reperfusion pulmonary edema (33 vs. 14%) and heart failure (23 vs. 3.3%) were all higher in group 1; however, after one year of follow-up, there were no significant differences in the clinical, hemodynamic and echocardiographic conditions of both groups. Survival rate after 5 years was 77% in group 1 and 92% in group 2 (P=.033). After the learning curve including the 46 first patients, there was no difference in hospital mortality (3.8 vs. 2.3%) or survival rate after 5 years (96.2% in group 1 and 96.2% in group 2).
  
  
  CONCLUSIONS
  Pulmonary thromboendarterectomy is linked to significantly higher morbidity and mortality rates in patients with severe chronic thromboembolic pulmonary hypertension. Nevertheless, these patients benefit the same from the procedure in the mid-/long-term. In our experience, after the learning curve, this surgery is safe in severe pulmonary hypertension and no level of pulmonary vascular resistance should be an absolute counter-indication for this surgery.
authors.affiliation: Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España. Electronic address: mjgude@gmail.com.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: López Gude
authors.affiliation: Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez de la Sota
authors.affiliation: Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Jose Luís
authors.initials: JL
authors.lastname: Pérez Vela
authors.affiliation: Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Jorge
authors.initials: J
authors.lastname: Centeno Rodríguez
authors.affiliation: Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Christian
authors.initials: C
authors.lastname: Muñoz Guijosa
authors.affiliation: Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Velázquez
authors.affiliation: Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Radiología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Sergio
authors.initials: S
authors.lastname: Alonso Chaterina
authors.affiliation: Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Hernández González
authors.affiliation: Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Escribano Subías
authors.affiliation: Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: José María
authors.initials: JM
authors.lastname: Cortina Romero
mesh_terms: D000368:Aged; D002908:Chronic Disease; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Hipertensión pulmonar; Pulmonary hypertension; Pulmonary thromboembolism; Pulmonary thromboendarterectomy; Tromboembolia pulmonar; Tromboendarterectomía pulmonar