María Lorena Coronel1, Núria Chamorro2, Isabel Blanco3, Verónica Amado2, Roberto Del Pozo2, José Luis Pomar4, Joan Ramón Badia3, Irene Rovira5, Purificación Matute5, Gemma Argemí2, Manuel Castellà6, Joan Albert Barberà7. 1. 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. 2. Servicio de Neumología y Alergia Respiratoria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España. 3. 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. 4. Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, España; Servicio de Cirugía Cardiovascular, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España. 5. Servicio de Anestesiología y Reanimación, Hospital Clínic, Universidad de Barcelona, Barcelona, España. 6. Servicio de Cirugía Cardiovascular, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España. 7. 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.
Abstract
INTRODUCTION: 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.
INTRODUCTION: 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 PEpatients 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: John E Cannon; Li Su; David G Kiely; Kathleen Page; Mark Toshner; Emilia Swietlik; Carmen Treacy; Anie Ponnaberanam; Robin Condliffe; Karen Sheares; Dolores Taboada; John Dunning; Steven Tsui; Choo Ng; Deepa Gopalan; Nicholas Screaton; Charlie Elliot; Simon Gibbs; Luke Howard; Paul Corris; James Lordan; Martin Johnson; Andrew Peacock; Robert MacKenzie-Ross; Benji Schreiber; Gerry Coghlan; Kostas Dimopoulos; Stephen J Wort; Sean Gaine; Shahin Moledina; David P Jenkins; Joanna Pepke-Zaba Journal: Circulation Date: 2016-04-06 Impact factor: 29.690
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Authors: John D L Brookes; Crystal Li; Sally T W Chung; Elizabeth M Brookes; Michael L Williams; Nicholas McNamara; Sofia Martin-Suarez; Antonio Loforte Journal: Ann Cardiothorac Surg Date: 2022-03
Authors: Nadine Al-Naamani; Gaudalupe Espitia H; Hugo Velazquez-Moreno; Benjamin Macuil-Chazaro; Arturo Serrano-Lopez; Ricardo S Vega-Barrientos; Nicholas S Hill; Ioana R Preston Journal: Lung Date: 2016-01-09 Impact factor: 2.584