Abstract
Background
Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic
thromboembolic pulmonary hypertension (PH). However, this surgery remains performed
in few experienced centres only. The goal of the study is to review our overall experience
since the implementation of our program in August 2005.
Methods
Review all patients referred to our program between August 2005 and July 2011.
Results
Among 84 consecutive patients referred to our program, 52 patients underwent elective
PEA and 6 emergency PEA. After PEA, 74% patients were extubated within 2 days, 71%
were discharged from the intensive care unit within 4 days and 64% were discharged
from hospital within 15 days. One patient undergoing elective surgery and 2 patients
undergoing emergency surgery died within 30 days of surgery for an operative mortality
of 1.9% after elective pulmonary endarterectomy and an overall operative mortality
of 5.2%, when the 6 emergency operative cases were included. The total pulmonary vascular
resistance decreased from 965 ± 445 to 383 ± 162 dynes per second per cm−5 and was associated with significant improvement in World Health Organization/New
York Heart Association (WHO/NYHA) functional class, 6 minutes walk distance, echocardiographic
findings, and brain natriuretic peptide level at 6 months after PEA. After a median
follow-up of 23 months (1-65 months), 3 patients had to be started on targeted PH
therapy for deterioration of their (WHO/NYHA) functional class.
Conclusions
Elective PEA can be performed with limited risk, and results in excellent early and
long-term outcome. All patients diagnosed with chronic thromboembolic PH should be
referred for consideration of PEA in a specialized centre.
Résumé
Introduction
L'endartérectomie pulmonaire (EAP) est le traitement de choix pour les patients atteint
d' hypertension pulmonaire thromboembolique chronique (HPTC). Toutefois, cette chirurgie
n'est pratiquée que dans quelques centres spécialisés. L'objectif de cette étude est
de revoir notre expérience globale depuis le début de notre programme en août 2005.
Méthodes
Tous les cas soumis à notre programme entre août 2005 et juillet 2011 ont été révisés.
Résultats
Parmi les 84 patients évalués, 52 ont subi une EAP élective et six ont été opérés
en urgence. En post-opératoire, 74 % ont été extubés en dedans de deux jours, 71 %
ont eu congé de l'unité de soins intensif en dedans de quatre jours et 64 % ont eu
congé de l'hôpital en moins de 15 jours. Un patient opéré de façon élective et deux
opérés en urgence sont décédés dans les 30 jours, pour une mortalité opératoire de
1,9 % en situation élective et 5,2 % en incluant les six cas opérés de façon urgente.
La résistance vasculaire pulmonaire totale (RVPt) a diminué de 965 ± 445 à 383 ± 162
Dynes.sec.cm−5, accompagnée d'une amélioration significative de la classe fonctionelle World Health Organization/New York Heart Association (WHO/NYHA), du test de marche de six minutes, de même que les données échocardiographiques
et le taux de peptide natriurétique cérébral (BNP) à six mois post-intervention. Après
un suivi moyen de 23 mois (1-65 mois), trois patients ont dû être traités médicalement
pour hypertension pulmonaire à cause d'une détérioration de leur classe fonctionelle
WHO/NYHA.
Conclusions
L'EAP élective peut être pratiquée avec un risque faible et s'accompagne d'excellents
résultats cliniques à court et à long termes. Tout patient porteur d'un diagnostic
d'HPTC devrait être dirigé vers un centre spécialisé afin d'envisager la possibilité
d'une EAP.
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Article info
Publication history
Published online: October 24, 2011
Accepted:
September 11,
2011
Received:
July 23,
2011
Footnotes
See editorial by Ryan et al., pages 671-674 in this issue.
See page 697 for disclosure information.
Identification
Copyright
© 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
