John E Cannon1, Li Su1, David G Kiely1, Kathleen Page1, Mark Toshner1, Emilia Swietlik1, Carmen Treacy1, Anie Ponnaberanam1, Robin Condliffe1, Karen Sheares1, Dolores Taboada1, John Dunning1, Steven Tsui1, Choo Ng1, Deepa Gopalan1, Nicholas Screaton1, Charlie Elliot1, Simon Gibbs1, Luke Howard1, Paul Corris1, James Lordan1, Martin Johnson1, Andrew Peacock1, Robert MacKenzie-Ross1, Benji Schreiber1, Gerry Coghlan1, Kostas Dimopoulos1, Stephen J Wort1, Sean Gaine1, Shahin Moledina1, David P Jenkins1, Joanna Pepke-Zaba2. 1. From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.). 2. From Papworth Hospital, Cambridge, United Kingdom (J.E.C., K.P., M.T., E.S., C.T., A. Ponnaberanam, K.S., D.T., J.D., S.T., C.N., N.S., D.P.T., J.P.-Z.); MRC Biostatistics Unit, Cambridge, United Kingdom (L.S.); Royal Hallamshire Hospital, Sheffield, United Kingdom (D.G.K., R.C., C.E.); Respiratory Medicine Department, University of Warmia and Mazury, Poland (E.S.); Hammersmith Hospital, London, United Kingdom (D.G., S. Gibbs, L.H.); Freeman Hospital, Newcastle, United Kingdom (P.C., J.L.); Golden Jubilee Hospital, Glasgow, United Kingdom (M.J., A. Peacock); Royal United Hospital, Bath, United Kingdom (R.M.-R.); Royal Free Hospital, London, United Kingdom (B.S., G.C.); Royal Brompton Hospital, London, United Kingdom (K.D., J.W.); Mater Misericordiae University Hospital, Dublin, Ireland (S. Gaine); and Great Ormond Street Hospital, London, United Kingdom (S.M.). joanna.pepkezaba@papworth.nhs.uk.
Abstract
BACKGROUND: Chronic thromboembolic pulmonary hypertension results from incomplete resolution of pulmonary emboli. Pulmonary endarterectomy (PEA) is potentially curative, but residual pulmonary hypertension following surgery is common and its impact on long-term outcome is poorly understood. We wanted to identify factors correlated with poor long-term outcome after surgery and specifically define clinically relevant residual pulmonary hypertension post-PEA. METHODS AND RESULTS: Eight hundred eighty consecutive patients (mean age, 57 years) underwent PEA for chronic thromboembolic pulmonary hypertension. Patients routinely underwent detailed reassessment with right heart catheterization and noninvasive testing at 3 to 6 months and annually thereafter with discharge if they were clinically stable at 3 to 5 years and did not require pulmonary vasodilator therapy. Cox regressions were used for survival (time-to-event) analyses. Overall survival was 86%, 84%, 79%, and 72% at 1, 3, 5, and 10 years for the whole cohort and 91% and 90% at 1 and 3 years for the recent half of the cohort. The majority of patient deaths after the perioperative period were not attributable to right ventricular failure (chronic thromboembolic pulmonary hypertension). At reassessment, a mean pulmonary artery pressure of ≥30 mm Hg correlated with the initiation of pulmonary vasodilator therapy post-PEA. A mean pulmonary artery pressure of ≥38 mm Hg and pulmonary vascular resistance ≥425 dynes·s(-1)·cm(-5) at reassessment correlated with worse long-term survival. CONCLUSIONS: Our data confirm excellent long-term survival and maintenance of good functional status post-PEA. Hemodynamic assessment 3 to 6 months and 12 months post-PEA allows stratification of patients at higher risk of dying of chronic thromboembolic pulmonary hypertension and identifies a level of residual pulmonary hypertension that may guide the long-term management of patients postsurgery.
BACKGROUND:Chronic thromboembolic pulmonary hypertension results from incomplete resolution of pulmonary emboli. Pulmonary endarterectomy (PEA) is potentially curative, but residual pulmonary hypertension following surgery is common and its impact on long-term outcome is poorly understood. We wanted to identify factors correlated with poor long-term outcome after surgery and specifically define clinically relevant residual pulmonary hypertension post-PEA. METHODS AND RESULTS: Eight hundred eighty consecutive patients (mean age, 57 years) underwent PEA for chronic thromboembolic pulmonary hypertension. Patients routinely underwent detailed reassessment with right heart catheterization and noninvasive testing at 3 to 6 months and annually thereafter with discharge if they were clinically stable at 3 to 5 years and did not require pulmonary vasodilator therapy. Cox regressions were used for survival (time-to-event) analyses. Overall survival was 86%, 84%, 79%, and 72% at 1, 3, 5, and 10 years for the whole cohort and 91% and 90% at 1 and 3 years for the recent half of the cohort. The majority of patient deaths after the perioperative period were not attributable to right ventricular failure (chronic thromboembolic pulmonary hypertension). At reassessment, a mean pulmonary artery pressure of ≥30 mm Hg correlated with the initiation of pulmonary vasodilator therapy post-PEA. A mean pulmonary artery pressure of ≥38 mm Hg and pulmonary vascular resistance ≥425 dynes·s(-1)·cm(-5) at reassessment correlated with worse long-term survival. CONCLUSIONS: Our data confirm excellent long-term survival and maintenance of good functional status post-PEA. Hemodynamic assessment 3 to 6 months and 12 months post-PEA allows stratification of patients at higher risk of dying of chronic thromboembolic pulmonary hypertension and identifies a level of residual pulmonary hypertension that may guide the long-term management of patients postsurgery.
Authors: David P Jenkins; Michael Madani; Eckhard Mayer; Kim Kerr; Nic Kim; Walter Klepetko; Marco Morsolini; Philippe Dartevelle Journal: Eur Respir J Date: 2012-11-08 Impact factor: 16.671
Authors: Dolores Taboada; Joanna Pepke-Zaba; David P Jenkins; Marius Berman; Carmen M Treacy; John E Cannon; Mark Toshner; John J Dunning; Choo Ng; Steven S Tsui; Karen K Sheares Journal: Eur Respir J Date: 2014-09-18 Impact factor: 16.671
Authors: Fraser D Rubens; Michael Bourke; Mark Hynes; Donna Nicholson; Marian Kotrec; Munir Boodhwani; Marc Ruel; Carole J Dennie; Thierry Mesana Journal: Ann Thorac Surg Date: 2007-03 Impact factor: 4.330
Authors: Patricia A Thistlethwaite; Kan Kaneko; Michael M Madani; Stuart W Jamieson Journal: Ann Thorac Cardiovasc Surg Date: 2008-10 Impact factor: 1.520
Authors: Emilia M Swietlik; Pavandeep Ghataorhe; Kasia I Zalewska; John Wharton; Luke S Howard; Dolores Taboada; John E Cannon; Nicholas W Morrell; Martin R Wilkins; Mark Toshner; Joanna Pepke-Zaba; Christopher J Rhodes Journal: Eur Respir J Date: 2021-04-01 Impact factor: 16.671
Authors: Evan L Brittain; Thennapan Thennapan; Bradley A Maron; Stephen Y Chan; Eric D Austin; Edda Spiekerkoetter; Harm J Bogaard; Christophe Guignabert; Roxane Paulin; Roberto F Machado; Paul B Yu Journal: Am J Respir Crit Care Med Date: 2018-07-01 Impact factor: 21.405
Authors: Marius M Hoeper; Hossein-Ardeschir Ghofrani; Ekkehard Grünig; Hans Klose; Horst Olschewski; Stephan Rosenkranz Journal: Dtsch Arztebl Int Date: 2017-02-03 Impact factor: 5.594
Authors: Sabine K Maschke; Jan B Hinrichs; Julius Renne; Thomas Werncke; Hinrich M B Winther; Kristina I Ringe; Karen M Olsson; Marius M Hoeper; Frank K Wacker; Bernhard C Meyer Journal: Eur Radiol Date: 2018-09-12 Impact factor: 5.315