Journal Article

Long-term Outcome after Pulmonary Endarterectomy

Corsico, Angelo G, Nicolardi, Salvatore, Klersy, Catherine, Monterosso, Cristian, Tramontin, Corrado, Niniano, Rosanna, Gatto, Elena, Morsolini, Marco, Pozzi, Ernesto, Cerveri, Isa, D'Armini, Andrea M, Ansaldo, Elena, Vigano, Mario

2008

Overview

There are few follow-up studies on long-term cardiopulmonary function after pulmonary endarterectomy (PEA), the operation of choice for chronic thromboembolic pulmonary hypertension (CTEPH). To prospectively evaluate long-term outcome of patients with CTEPH treated with PEA. Between 1994 and 2006, 157 patients (mean age 55 yr) were treated with PEA at Pavia University Hospital. The patients were evaluated before PEA and at 3 months (n = 132), 1 year (n = 110), 2 years (n = 86), 3 years (n = 69), and 4 years (n = 49) afterward by NYHA class, right heart hemodynamic, spirometry, carbon monoxide transfer factor (Tl(CO)), arterial blood gas, and treadmill incremental exercise test. Cumulative survival was 84%. Within 3 months, 18 patients died in-hospital and 2 had lung transplantation; during long-term follow-up, 6 died, 1 had lung transplantation, and 3 had a second PEA (2.5 events per 100 person-years). NYHA class III-IV was the most important predictor of late death, lung transplant, or PEA redo (hazard ratio, 3.94). Extraordinary improvement in NYHA class, hemodynamic, and Pa(O(2)) were achieved in the first 3 months (P < 0.001) and persisted during follow-up; exercise tolerance progressively increased over time (P < 0.001). At 4 years, although 74% of the patients were in NYHA class I and none was in class IV, 24% had pulmonary vascular resistance greater than 500 dyne.s/cm(5) or Pa(O(2)) less than 60 mm Hg; they were significantly older and were more frequently in NYHA class III-IV 3 months after surgery than the others. After PEA, long-term survival and cardiopulmonary function recovery is excellent in most patients.

• Publisher: Am Thoracic Soc,American Lung Association,American Thoracic Society
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Biological and medical sciences / Child / Chronic Disease / Endarterectomy / Exercise / Exercise Test / Female / Fibromuscular Dysplasia - surgery / Fitness equipment / Follow-Up Studies / Hemodynamics / Hemodynamics - physiology / Hospital Mortality / Humans / Hypertension, Pulmonary - surgery / Intensive care medicine / Lung transplants / Male / Medical sciences / Middle Aged / Oxygen - blood / Patients / Physical fitness / Pneumology / Postoperative Complications - etiology / Postoperative Complications - mortality / Postoperative Complications - physiopathology / Prospective Studies / Pulmonary arteries / Pulmonary Artery - surgery / Pulmonary Diffusing Capacity - physiology / Pulmonary Embolism - surgery / Pulmonary Gas Exchange - physiology / Pulmonary hypertension / Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases / Respiratory failure / Respiratory Insufficiency - etiology / Respiratory Insufficiency - mortality / Respiratory Insufficiency - physiopathology / Spirometry / Surgery / Survival Rate / Thromboembolism / Vascular Resistance - physiology / Veins & arteries / Ventricular Function, Right - physiology