Back to Search Start Over

Outcome after pulmonary endarterectomy for segmental chronic thromboembolic pulmonary hypertension.

Authors :
de Perrot M
Donahoe L
McRae K
Thenganatt J
Moric J
Chan J
McInnis M
Jumaa K
Tan KT
Mafeld S
Granton J
Source :
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2022 Sep; Vol. 164 (3), pp. 696-707.e4. Date of Electronic Publication: 2022 Mar 01.
Publication Year :
2022

Abstract

Objective: Determine the long-term outcome and need for additional therapy after pulmonary endarterectomy (PEA) for segmental chronic thromboembolic pulmonary hypertension.<br />Methods: Retrospective analysis of a prospective cohort of 401 consecutive Canadian patients undergoing PEA between August 2005 and March 2020 in Toronto. The outcome of segmental disease defined as Jamieson type 3 was compared with more proximal disease defined as Jamieson type 1 and 2. The cohort was divided into 3 intervals to analyze the trend over time: 2005-2010, 2011-2015, and 2016-2020.<br />Results: Type 3 disease accounted for 41% of patients undergoing PEA durig 2016-2020 compared with 7% in 2006-2010. Total pulmonary vascular resistance improved by 505 ± 485 dynes/s/cm <superscript>-5</superscript> in type 3 disease and by 593 ± 452 dynes/s/cm <superscript>-5</superscript> in type 1 or 2 disease (P = .07). Mortality after PEA was similar between type 3 and type 1 and 2 disease at 30-days (2.8% vs 2.3%; P = .8) and at 1 year (7.7% vs 5.5%; P = .4). At 5 years, the survival was lower in type 3 disease (80% vs 91% in type 1 or 2 disease; P = .002). Type 3 disease was an independent predictor for the initiation of pulmonary hypertension-targeted medical therapy after PEA with a cumulative incidence of 38% at 10 years compared with 20% in type 1 and 2 disease (P < .0001). Post-PEA balloon pulmonary angioplasty was predominantly performed in type 3 disease (8% vs 1% in more type 1 or 2 disease; P = .0002).<br />Conclusions: PEA achieved excellent early and long-term results in segmental chronic thromboembolic pulmonary hypertension. However, patients with segmental disease are at increased risk of requiring additional therapy after PEA and should be carefully monitored.<br /> (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1097-685X
Volume :
164
Issue :
3
Database :
MEDLINE
Journal :
The Journal of thoracic and cardiovascular surgery
Publication Type :
Academic Journal
Accession number :
35361492
Full Text :
https://doi.org/10.1016/j.jtcvs.2021.10.078