Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: Results from an international prospective registry

Eckhard Mayer, David Jenkins, Jaroslav Lindner, Andrea D'Armini, Jaap Kloek, Bart Meyns, Lars Bo Ilkjaer, Walter Klepetko, Marion Delcroix, Irene Lang, Joanna Pepke-Zaba, Gerald Simonneau, Philippe Dartevelle

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Abstract

Objective: Pulmonary endarterectomy is a curative surgical treatment option for the majority of patients with chronic thromboembolic pulmonary hypertension. The current surgical management and postoperative outcome of patients enrolled in an international registry on chronic thromboembolic pulmonary hypertension were investigated. Methods: The registry included newly diagnosed (≤6 months) consecutive patients with chronic thromboembolic pulmonary hypertension from February 2007 to January 2009. Results: A total of 679 patients were registered from 1 Canadian and 26 European centers, of whom 386 (56.8%) underwent surgery. The median age of patients undergoing surgery was 60 years, and 54.1% were male. Previous pulmonary embolism was confirmed for 79.8% of patients. Perioperative complications occurred in 189 patients (49.2%): infection (18.8%), persistent pulmonary hypertension (16.7%), neurologic (11.2%) or bleeding (10.2%) complications, pulmonary reperfusion edema (9.6%), pericardial effusion (8.3%), need for extracorporeal membrane oxygenation (3.1%), and in-hospital mortality due to perioperative complications (4.7%). Documented 1-year mortality was 7%. Preoperative exercise capacity was predictive of 1-year mortality. Postoperative pulmonary vascular resistance predicted in-hospital and 1-year mortality. In patients evaluated within 1 year after surgery, the median pulmonary vascular resistance had decreased from 698 to 235 dyn.s.cm-5 (95% confidence limit, 640-874 and 211-255, respectively, n = 70) and the median 6-minute walk distance had increased from 362 to 459 m (95% confidence limit, 340-399 and 440-473, respectively, n = 168). New York Heart Association functional class improved with most patients progressing from class III/IV to class I/II. Conclusions: Pulmonary endarterectomy is associated with a low in-hospital mortality rate and improvements in hemodynamics and exercise capacity.

Original languageEnglish
Pages (from-to)702-709
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume141
Issue number3
DOIs
Publication statusPublished - Mar 2011

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Keywords

  • chronic thromboembolic pulmonary hypertension
  • CL
  • computed tomography
  • confidence limit
  • CT
  • CTEPH
  • mean pulmonary artery pressure
  • mPAP
  • New York Heart Association
  • NYHA
  • odds ratio
  • OR
  • PAH
  • PEA
  • pulmonary arterial hypertension
  • pulmonary endarterectomy
  • pulmonary vascular resistance
  • PVR

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Mayer, E., Jenkins, D., Lindner, J., D'Armini, A., Kloek, J., Meyns, B., Ilkjaer, L. B., Klepetko, W., Delcroix, M., Lang, I., Pepke-Zaba, J., Simonneau, G., & Dartevelle, P. (2011). Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: Results from an international prospective registry. Journal of Thoracic and Cardiovascular Surgery, 141(3), 702-709. https://doi.org/10.1016/j.jtcvs.2010.11.024