Original article
Cardiovascular
Japanese Single-Center Experience of Surgery for Chronic Thromboembolic Pulmonary Hypertension

https://doi.org/10.1016/j.athoracsur.2006.03.121Get rights and content

Background

We review the outcome of surgery for chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

Between 1995 and 2004, 88 patients underwent surgery for CTEPH. Mean pulmonary artery pressure and pulmonary vascular resistance were 46 mm Hg (range, 23 to 70 mm Hg) and 986 dynes · sec−1 · cm−5 (298 to 2,231 dynes · sec−1 · cm−5). The pulmonary artery lesion was proximally located in 51 patients, subsegmental in 34 patients, and peripheral in 3 patients. Pulmonary endarterectomy was performed using cycles of 15-minute intermittent circulatory arrest followed by 10-minute reperfusion at 16°C to 18°C.

Results

The median durations of circulatory arrest, cardiopulmonary bypass, and surgery were 58, 217, and 355 minutes, respectively. Percutaneous extracorporeal membrane oxygenation was used in 8 patients (9.1%) who had difficulty being weaning from cardiopulmonary bypass. Three recent patients for whom this was performed promptly were weaned and survived. There were 7 hospital deaths (8.0%, including 6 30-day deaths) from pulmonary bleeding in 2 patients, residual pulmonary hypertension in 3, rupture of bulla in 1, and empyema in 1. In the 81 survivors, mean pulmonary artery pressure and pulmonary vascular resistance fell significantly after surgery (p < 0.0001, each case). Age more than 60 years was a risk factor for hospital mortality on multivariate analysis. Although distal pulmonary artery disease including subsegmental and peripheral lesions was not a significant risk factor for mortality, it did influence patient recovery: the frequency of percutaneous extracorporeal membrane oxygenation was higher and hemodynamic improvement less pronounced in patients with distal disease. The actuarial survival rate was 90.7% at 3 years and 86.4% at 5 years. None of the patients have suffered recurrence. The event-free rate was 97.1% at 3 years and 93.5% at 5 years. Of the 68 patients surviving for more than 1 year after surgery, 67.6% were successfully weaned from home oxygen therapy and 13.2% required only occasional use of oxygen.

Conclusions

Pulmonary endarterectomy can be safely performed with relatively low mortality and favorable prognosis with long-term survival, although it should be performed carefully for patients with distal disease.

Section snippets

Patients

Between 1995 and 2004, 88 patients with a mean age of 52.3 ± 13.1 years (range, 19 to 79) underwent surgery for CTEPH at the National Cardiovascular Center, Osaka, Japan. Institutional approval for this study was obtained, and each patient in the study gave informed consent to serve as a subject. A total of 60% were female. There were two peaks in the distribution of age and sex: a small peak of young males with coagulation abnormality, and a large peak of middle-age females. By etiology of

Results

The median durations of profound hypothermic circulatory arrest, cardiopulmonary bypass, and surgery were 58 minutes (24 to 99), 217 minutes (119 to 434), and 355 minutes (240 to 715), respectively. Median amounts of bleeding and blood transfusion were 1,153 mL (103 to 3,150) and 737 mL (0 to 6,000), respectively. Forty-five patients (51.1%) required no blood transfusion. Thirty-eight patients (43.2%) were extubated within 24 hours of completion of surgery. The duration of mechanical

Comment

Since the San Diego group began performing pulmonary endarterectomy for CTEPH [1, 2, 3], the indications and procedures used for this surgery have become well established, and several reports of successful outcomes have been published [4, 5, 6]. However, surgery for CTEPH is still technically demanding and risky. For patients with distal pulmonary artery disease, surgery is more difficult and its outcome poor, even at San Diego [4, 5, 6].

In the present retrospective study, the overall outcome

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  • Efficacy and safety of balloon pulmonary angioplasty for residual pulmonary hypertension after pulmonary endarterectomy

    2021, International Journal of Cardiology
    Citation Excerpt :

    Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by pulmonary artery stenosis or obstruction because of organised thrombi [1,2]. Pulmonary endarterectomy (PEA) is the standard treatment for CTEPH [2–8]. Although improvements in PEA technology provided better surgical outcomes [8,9], patients are not good candidates for PEA if they have a peripherally located organised thrombus and/or comorbidities [3].

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