María Jesús López Gude1, Enrique Pérez de la Sota2, Jose Luís Pérez Vela3, Jorge Centeno Rodríguez2, Christian Muñoz Guijosa2, María Teresa Velázquez4, Sergio Alonso Chaterina5, Ignacio Hernández González4, Pilar Escribano Subías4, José María Cortina Romero2. 1. 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. 2. Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cirugía Cardiaca, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España. 3. Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España. 4. Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España. 5. Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Radiología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
Abstract
BACKGROUND AND 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. MATERIAL AND 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.
BACKGROUND AND 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. MATERIAL AND 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: María Jesús López-Gude; Isabel Blanco; Victoria Benito-Arnáiz; Manel Castellà; Pilar Escribano-Subías; Clara Martin; Joan Albert Barberà; José María Cortina-Romero Journal: Ann Cardiothorac Surg Date: 2022-03
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