BACKGROUND: Surgical pulmonary endarterectomy is the preferred treatment for chronic thromboembolic pulmonary hypertension. Persistent pulmonary hypertension after pulmonary endarterectomy has been recognized as a major determinant of poor outcome. We tested whether acute vasoreactivity identifies chronic thromboembolic pulmonary hypertension patients prone to develop persistent/recurrent pulmonary hypertension after pulmonary endarterectomy and whether the degree of acute vasoreactivity affects survival or freedom from lung transplantation. METHODS AND RESULTS: Right-sided heart catheterization at baseline and after inhalation of 40 ppm nitric oxide for 20 minutes was performed in 103 patients (56.3+/-15.3 years old, 53 women). Reductions in mean pulmonary arterial pressure (DeltamPAP; -8.8+/-12.6%; P<0.0001) and pulmonary vascular resistance (-16.1+/-18.1%; P<0.0001) and an increase in mixed venous saturation during inhaled nitric oxide (9.1+/-11.6%; P<0.0001) were observed. Sixty-two patients underwent pulmonary endarterectomy after a median of 49 days (25th and 75th percentiles: 24 and 123 days). Operated patients were followed up for a median of 70.9 months (25th and 75th percentiles: 14 and 97 months). Change in mPAP during inhaled NO was identified as a predictor of persistent/recurrent pulmonary hypertension after pulmonary endarterectomy. Patients experiencing a reduction in mPAP >10.4% with nitric oxide inhalation had a better postoperative outcome. A significant correlation was found between DeltamPAP and immediate postoperative pulmonary vascular resistance (r=0.5, P<0.0001). CONCLUSIONS: A total of 80 (77.7%) of 103 patients demonstrated acute pulmonary vascular reactivity of some degree. A decrease in mPAP >10.4% under inhaled nitric oxide is a predictor of long-term survival and freedom from lung transplantation in adult patients with chronic thromboembolic pulmonary hypertension who are undergoing pulmonary endarterectomy.
BACKGROUND: Surgical pulmonary endarterectomy is the preferred treatment for chronic thromboembolic pulmonary hypertension. Persistent pulmonary hypertension after pulmonary endarterectomy has been recognized as a major determinant of poor outcome. We tested whether acute vasoreactivity identifies chronic thromboembolic pulmonary hypertensionpatients prone to develop persistent/recurrent pulmonary hypertension after pulmonary endarterectomy and whether the degree of acute vasoreactivity affects survival or freedom from lung transplantation. METHODS AND RESULTS: Right-sided heart catheterization at baseline and after inhalation of 40 ppm nitric oxide for 20 minutes was performed in 103 patients (56.3+/-15.3 years old, 53 women). Reductions in mean pulmonary arterial pressure (DeltamPAP; -8.8+/-12.6%; P<0.0001) and pulmonary vascular resistance (-16.1+/-18.1%; P<0.0001) and an increase in mixed venous saturation during inhaled nitric oxide (9.1+/-11.6%; P<0.0001) were observed. Sixty-two patients underwent pulmonary endarterectomy after a median of 49 days (25th and 75th percentiles: 24 and 123 days). Operated patients were followed up for a median of 70.9 months (25th and 75th percentiles: 14 and 97 months). Change in mPAP during inhaled NO was identified as a predictor of persistent/recurrent pulmonary hypertension after pulmonary endarterectomy. Patients experiencing a reduction in mPAP >10.4% with nitric oxide inhalation had a better postoperative outcome. A significant correlation was found between DeltamPAP and immediate postoperative pulmonary vascular resistance (r=0.5, P<0.0001). CONCLUSIONS: A total of 80 (77.7%) of 103 patients demonstrated acute pulmonary vascular reactivity of some degree. A decrease in mPAP >10.4% under inhaled nitric oxide is a predictor of long-term survival and freedom from lung transplantation in adult patients with chronic thromboembolic pulmonary hypertension who are undergoing pulmonary endarterectomy.
Authors: Sanjay Mehta; Doug Helmersen; Steeve Provencher; Naushad Hirani; Fraser D Rubens; Marc De Perrot; Mark Blostein; Kim Boutet; George Chandy; Carole Dennie; John Granton; Paul Hernandez; Andrew M Hirsch; Karen Laframboise; Robert D Levy; Dale Lien; Simon Martel; Gerard Shoemaker; John Swiston; Justin Weinkauf Journal: Can Respir J Date: 2010 Nov-Dec Impact factor: 2.409
Authors: Stephen J Halliday; Anna R Hemnes; Ivan M Robbins; Meredith E Pugh; David X Zhao; Robert N Piana; Pete P Fong; Evan L Brittain Journal: J Heart Lung Transplant Date: 2014-11-04 Impact factor: 10.247
Authors: Caio Julio Cesar Dos Santos Fernandes; Jaquelina Sonoe Ota-Arakaki; Frederico Thadeu Assis Figueiredo Campos; Ricardo de Amorim Correa; Marcelo Basso Gazzana; Carlos Vianna Poyares Jardim; Fábio Biscegli Jatene; Jose Leonidas Alves Junior; Roberta Pulcheri Ramos; Daniela Tannus; Carlos Teles; Mario Terra Filho; Daniel Waetge; Rogerio Souza Journal: J Bras Pneumol Date: 2022-06-24 Impact factor: 2.800
Authors: Guido Claessen; Andre La Gerche; Steven Dymarkowski; Piet Claus; Marion Delcroix; Hein Heidbuchel Journal: J Am Heart Assoc Date: 2015-03-23 Impact factor: 5.501