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The Journal of Cardiovascular Surgery 2018 June;59(3):428-37

DOI: 10.23736/S0021-9509.17.10188-6


lingua: Inglese

Initial clinical and hemodynamic results of a regional pulmonary thromboendarterectomy program

Farhan RAZA 1, Anjali VAIDYA 1, Anne-Sophie LACHARITE-ROBERGE 2, Vladimir LAKHTER 1, Hayan AL-MALULI 1, Irfan AHSAN 3, Pamela BOODRAM 4, Chandra DASS 5, Frances ROGERS 1, Martin G. KEANE 1, Sheila WEAVER 6, Riyaz BASHIR 1, Yoshiya TOYODA 7, Paul FORFIA 1

1 Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA, USA; 2 Department of Medicine, Temple University Hospital, Philadelphia, PA, USA; 3 Department of Medicine, Abington Memorial Hospital, Philadelphia, PA, USA; 4 Temple University School of Medicine, Philadelphia, PA, USA; 5 Department of Radiology, Temple University Hospital, Philadelphia, PA, USA; 6 Temple Lung Center, Temple University Hospital, Philadelphia, PA, USA; 7 Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA, USA


BACKGROUND: Pulmonary thromboendarterectomy (PTE) is the treatment of choice for eligible patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, access to CTEPH and PTE care is limited. There is a paucity of published data on PTE efficacy and outcomes from alternative, regional centers of excellence in CTEPH and PTE care in the USA, outside a single national and international referral center.
METHODS: We performed a retrospective review of patients undergoing PTE at our institution from June 2013 to December 2016 (42 months), and collected clinical, echocardiographic and hemodynamic data on our patients pre- and post-PTE (N.=71).
RESULTS: Patients age ranged between 20-83 years (mean±SD: 56±16), with 54% of patients female and 61% Caucasians. The predominant symptom was shortness of breath with a median duration of symptoms of 17 months. Following PTE, clinical improvements included a reduction in NYHA class from 3.1±1.1 to 2.2±1.2. There were major improvements in hemodynamics and echocardiographic parameters pre- versus post-PTE: mean pulmonary artery pressure (mmHg) 45±11 to 24±8, cardiac index (L/min/m2) 2.1±0.5 to 2.8±0.5, pulmonary vascular resistance (mmHg/L/min) 8.9±4.5 to 2.8±1.8, ratio of right ventricle (RV): left ventricle (LV) 1.2±0.3 to 0.9±0.2, RV fractional area change (%) 23±14 to 44±13, reduction in the incidence of RV outflow tract Doppler notching and improved pulmonary artery acceleration time (96% to 30%, and 74±19 to 111±21). In-hospital mortality was 4.2% (3 patients).
CONCLUSIONS: Herein, we report for the first time, the improvements in patient functionality, hemodynamics, right heart function and outcomes at a major regional PTE program.

KEY WORDS: Hypertension, pulmonary - Endarterectomy - Heart ventricles

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