John D L Brookes1,2, Crystal Li2,3, Sally T W Chung2,4, Elizabeth M Brookes5, Michael L Williams2,6, Nicholas McNamara2,7, Sofia Martin-Suarez8, Antonio Loforte8. 1. Department of Cardiothoracic Surgery, University Hospital Geelong, Barwon Health, Geelong, Australia. 2. The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia. 3. Department of Surgery, Westmead Hospital, Sydney, Australia. 4. School of Medicine, University of New South Wales, Sydney, Australia. 5. Department of Medicine, St Vincent's Hospital, Melbourne, Australia. 6. Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia. 7. Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia. 8. S. Orsola University Hospital, IRCCS Bologna, Division of Cardiac Surgery, Bologna, Italy.
Abstract
Background: Pulmonary thromboendarterectomy (PTE) is the gold standard treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, the results are poorly quantified outside a few registry reports and several individual centers. Methods: A systematic review was performed searching five electronic databases assessing the outcomes for adult patients undergoing PTE for CTEPH. All articles that reported mortality data were included. Primary outcome measures were early/inpatient mortality; secondary outcomes were survival, pulmonary haemodynamics, morbidity and functional status following PTE for CTEPH. Results were pooled via a meta-analysis of proportions and meta-regression. Results: A total of 5,717 studies were identified, yielding sixty-one relevant papers. Thirty-day mortality ranged from 0.8% to 24.4%, and on meta-analysis was 8.4% [95% confidence interval (CI): 7.2-9.6%]. Mortality was noted to decrease with increasing center volume of PTE cases (P<0.01). Residual pulmonary hypertension was reported in 8.2% to 44.5% of patients. Conclusions: CTEPH is associated with acceptable short-term mortality and an improvement in pulmonary hemodynamics. With increasing volume of experience and ongoing developments over time peri-operative mortality continues to decrease. 2022 Annals of Cardiothoracic Surgery. All rights reserved.
Background: Pulmonary thromboendarterectomy (PTE) is the gold standard treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, the results are poorly quantified outside a few registry reports and several individual centers. Methods: A systematic review was performed searching five electronic databases assessing the outcomes for adult patients undergoing PTE for CTEPH. All articles that reported mortality data were included. Primary outcome measures were early/inpatient mortality; secondary outcomes were survival, pulmonary haemodynamics, morbidity and functional status following PTE for CTEPH. Results were pooled via a meta-analysis of proportions and meta-regression. Results: A total of 5,717 studies were identified, yielding sixty-one relevant papers. Thirty-day mortality ranged from 0.8% to 24.4%, and on meta-analysis was 8.4% [95% confidence interval (CI): 7.2-9.6%]. Mortality was noted to decrease with increasing center volume of PTE cases (P<0.01). Residual pulmonary hypertension was reported in 8.2% to 44.5% of patients. Conclusions: CTEPH is associated with acceptable short-term mortality and an improvement in pulmonary hemodynamics. With increasing volume of experience and ongoing developments over time peri-operative mortality continues to decrease. 2022 Annals of Cardiothoracic Surgery. All rights reserved.
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