Pulmonary Thromboendarterectomy in 106 Patients With Chronic Thromboembolic Pulmonary Hypertension

• Published in: Archivos de bronconeumología (English ed.) 2015-10, Vol.51 (10), p.502-508
• Main Authors: López Gude, María Jesús, Pérez de la Sota, Enrique, Forteza Gil, Alberto, Centeno Rodríguez, Jorge, Eixerés, Andrea, Velázquez, María Teresa, Sánchez Nistal, María Antonia, Pérez Vela, José Luis, Ruiz Cano, María José, Gómez Sanchez, Miguel Ángel, Escribano Subías, Pilar, Cortina Romero, José María
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cardiopulmonary Bypass; Chronic Disease; Endarterectomy - methods; Endarterectomy - statistics & numerical data; Female; Follow-Up Studies; Hipertensión pulmonar; Hospital Mortality; Humans; Hypertension, Pulmonary - etiology; Hypothermia, Induced; Hypoxia - etiology; Hypoxia - therapy; Internal Medicine; Kaplan-Meier Estimate; Male; Middle Aged; Postoperative Complications - etiology; Postoperative Complications - mortality; Postoperative Complications - therapy; Pulmonary Embolism - complications; Pulmonary Embolism - surgery; Pulmonary hypertension; Pulmonary thromboembolism; Pulmonary thromboendarterectomy; Pulmonary/Respiratory; Recovery of Function; Reperfusion Injury - etiology; Reperfusion Injury - therapy; Respiration, Artificial; Thrombectomy - methods; Thrombectomy - statistics & numerical data; Treatment Outcome; Tromboembolismo pulmonar; Tromboendarterectomía pulmonar; Vascular Resistance; Young Adult
• ISSN: 1579-2129; 1579-2129
• DOI: 10.1016/j.arbr.2015.05.014

Abstract Introduction Pulmonary thromboendarterectomy is the treatment of choice in chronic thromboembolic pulmonary hypertension. We report our experience with this technique. Methods Between February 1996 and June 2014, we performed 106 pulmonary thromboendarterectomies. Patient population, morbidity and mortality and the long-term results of this technique (survival, functional improvement and resolution of pulmonary hypertension) are described. Results Subjects’ mean age was 53±14 years. A total of 89% were WHO functional class III – IV , presurgery mean pulmonary pressure was 49±13 mmHg and mean pulmonary vascular resistance was 831±364 dynes s cm−5 . In-hospital mortality was 6.6%. The most important post-operative morbidity was reperfusion pulmonary injury, in 20% of patients; this was an independent risk factor ( P =.015) for hospital mortality. With a 31-month median follow-up (interquartile range: 50), 3- and 5-year survival was 90% and 84% respectively. At 1 year, 91% were WHO functional class I – II ; mean pulmonary pressure (27±11 mmHg) and pulmonary vascular resistance (275±218 dynes s cm−5 ) were significantly lower ( P