Pulmonary thromboendarterectomy: The Marie Lannelongue Hospital experience.
Chronic thromboembolic pulmonary hypertension (CTEPH)
balloon pulmonary angioplasty (BPA)
circulatory arrest
deep hypothermia
pulmonary endarterectomy (PEA)
pulmonary vascular disease
Journal
Annals of cardiothoracic surgery
ISSN: 2225-319X
Titre abrégé: Ann Cardiothorac Surg
Pays: China
ID NLM: 101605877
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
02
11
2021
accepted:
18
03
2022
entrez:
18
4
2022
pubmed:
19
4
2022
medline:
19
4
2022
Statut:
ppublish
Résumé
Targeted medical therapy and balloon pulmonary angioplasty (BPA) entered the field of chronic thromboembolic pulmonary hypertension (CTEPH) treatment in the early 2010's. Multimodal therapy is emerging as the new gold standard for CTEPH management. Whether this change of paradigm impacted early outcomes of pulmonary endarterectomy (PEA) remains unknown. Our aim is to report our surgical experience in the era of CTEPH multimodal management. Patients who underwent PEA between 2016 and 2020 were included in the study. Early outcomes were described and compared between three groups of patients: PEA alone, PEA after targeted medical therapy induction and PEA after BPA. A total of 418 patients, 225 males and 193 females, with a mean age of 59±14 years were included in the study. 336 patients underwent PEA alone, 69 after medical targeted therapy induction and 13 after unilateral BPA. Baseline preoperative pulmonary vascular resistance [4.99 (IQR, 1.71-8.48), 6.21 (IQR, 4.37-8.1), 5.03 (IQR, 4.44-7.19) wood units (WU), P=0.230, respectively] and PEA effectiveness [% decrease mean pulmonary artery pressure (mPAP), 24 (IQR, 7-42), 25 (IQR, 7-35), 23 (IQR, 3-29), P=0.580] did not differ between groups. Compared to PEA alone and PEA+BPA, the medical therapy induction group represented the most challenging group with higher baseline mPAP (45±10 Multimodal therapy approach to CTEPH patients did not affect effectiveness of PEA. Medical therapy and BPA could act in synergy with surgery to treat more challenging patients.
Sections du résumé
Background
UNASSIGNED
Targeted medical therapy and balloon pulmonary angioplasty (BPA) entered the field of chronic thromboembolic pulmonary hypertension (CTEPH) treatment in the early 2010's. Multimodal therapy is emerging as the new gold standard for CTEPH management. Whether this change of paradigm impacted early outcomes of pulmonary endarterectomy (PEA) remains unknown. Our aim is to report our surgical experience in the era of CTEPH multimodal management.
Methods
UNASSIGNED
Patients who underwent PEA between 2016 and 2020 were included in the study. Early outcomes were described and compared between three groups of patients: PEA alone, PEA after targeted medical therapy induction and PEA after BPA.
Results
UNASSIGNED
A total of 418 patients, 225 males and 193 females, with a mean age of 59±14 years were included in the study. 336 patients underwent PEA alone, 69 after medical targeted therapy induction and 13 after unilateral BPA. Baseline preoperative pulmonary vascular resistance [4.99 (IQR, 1.71-8.48), 6.21 (IQR, 4.37-8.1), 5.03 (IQR, 4.44-7.19) wood units (WU), P=0.230, respectively] and PEA effectiveness [% decrease mean pulmonary artery pressure (mPAP), 24 (IQR, 7-42), 25 (IQR, 7-35), 23 (IQR, 3-29), P=0.580] did not differ between groups. Compared to PEA alone and PEA+BPA, the medical therapy induction group represented the most challenging group with higher baseline mPAP (45±10
Conclusions
UNASSIGNED
Multimodal therapy approach to CTEPH patients did not affect effectiveness of PEA. Medical therapy and BPA could act in synergy with surgery to treat more challenging patients.
Identifiants
pubmed: 35433355
doi: 10.21037/acs-2021-pte-20
pii: acs-11-02-143
pmc: PMC9012189
doi:
Types de publication
Journal Article
Langues
eng
Pagination
143-150Informations de copyright
2022 Annals of Cardiothoracic Surgery. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: OM, EF, MH, XJ and GS are members of MSD scientific board on CTEPH.
Références
J Heart Lung Transplant. 2021 Nov;40(11):1301-1326
pubmed: 34420851
J Heart Lung Transplant. 2018 Sep;37(9):1102-1110
pubmed: 30037729
Circulation. 2016 Mar 1;133(9):859-71
pubmed: 26826181
Eur Respir J. 2019 May 18;53(5):
pubmed: 31023842
Eur Respir J. 2004 Apr;23(4):637-48
pubmed: 15083767
Interact Cardiovasc Thorac Surg. 2016 Jul;23(1):74-8
pubmed: 27030685
N Engl J Med. 2013 Jul 25;369(4):330-40
pubmed: 23883378
Int J Cardiol. 2016 Nov 1;222:39-40
pubmed: 27448704
J Heart Lung Transplant. 2016 May;35(5):591-6
pubmed: 26612053
Interact Cardiovasc Thorac Surg. 2016 Feb;22(2):181-7
pubmed: 26612405
J Thorac Cardiovasc Surg. 2011 Mar;141(3):702-10
pubmed: 21335128
Eur J Cardiothorac Surg. 2012 Jun;41(6):e154-60
pubmed: 22593260
J Thorac Cardiovasc Surg. 2014 Sep;148(3):1005-11; 1012.e1-2; discussion 1011-2
pubmed: 25129589
Ann Thorac Surg. 2012 Jul;94(1):97-103; discussion 103
pubmed: 22626752
Ann Thorac Surg. 2016 Jul;102(1):260-8
pubmed: 27112656