Pulmonary Hypertensive Medical Therapy in Chronic Thromboembolic Pulmonary Hypertension Before Pulmonary Thromboendarterectomy
Pulmonary Hypertensive Medical Therapy in Chronic Thromboembolic Pulmonary Hypertension Before Pulmonary Thromboendarterectomy
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DOI：
10.1161/circulationaha.109.865881
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发表时间：
2009-09-29
期刊：
影响因子：
37.8
通讯作者：
Auger, William R.
中科院分区：
文献类型：
--
作者：
Jensen, Kurt W.;Kerr, Kim M.;Auger, William R.
背景：目前推荐的治疗慢性血栓栓塞性肺动脉高压的方法是肺血栓动脉内膜切除术（PTE）。没有令人信服的证据表明肺动脉高压药物治疗（PHT）在可手术的候选者中存在。我们试图确定PTE转诊时使用PHT的流行程度，以及对PTE前和PTE后结果/血流动力学的影响。方法和结果：我们对2005-2007年间因PTE就诊的慢性血栓栓塞性肺动脉高压患者进行了回顾性分析。我们对所有转介到我们机构的患者进行了PHT患病率测定。血液动力学和结果分析仅涉及接受PTE治疗的患者，数据包括基线人口统计学、PHT药物、剂量、治疗持续时间和转诊时间。从诊断时、转诊时和PTE后获得血流动力学数据。结果包括重症监护病房、住院天数和呼吸机天数；出血和感染率；再灌注肺损伤发生率；还有住院死亡率。对照组（n=244）与PHT组（n=111）比较；亚组包括波生坦、西地那非或丙烯醇单药治疗和联合治疗。PHT患病率从2005年的19.9%显著上升至2007年的37%。PHT治疗对PTE前平均肺动脉压的影响很小，但它的使用与PTE转诊的时间明显延迟有关，两组在PTE后的血流动力学参数都有显著改善，两组在PTE后的任何结果没有显著差异。各亚组的结果相似。结论：我们的研究结果表明，使用PHT对pte前的血流动力学影响很小，对pte后的结果/血流动力学没有影响。（Circulation. 2009; 120: 1248-1254.）
Background-The currently recommended treatment for chronic thromboembolic pulmonary hypertension is pulmonary thromboendarterectomy (PTE). No convincing evidence for the use of pulmonary hypertensive medical therapy (PHT) exists in operable candidates. We sought to determine the prevalence of the use of PHT on referral for PTE and the effects on pre-PTE hemodynamics and post-PTE outcomes/hemodynamics.Methods and Results-We performed a retrospective analysis of chronic thromboembolic pulmonary hypertension patients referred for PTE during 2005-2007. The prevalence of PHT was determined for all patients referred to our institution. Hemodynamic and outcomes analysis involved only those undergoing PTE. Data included baseline demographics, PHT medication(s), dosage, duration of therapy, and time to referral. Hemodynamic data were acquired from the time of diagnosis, the time of referral visit, and after PTE. Outcomes included intensive care unit, hospital, and ventilator days; bleeding and infection rates; incidence of reperfusion lung injury; and in-hospital mortality. The control group (n=244) was compared with the PHT group (n=111); subgroups included monotherapy with bosentan, sildenafil, or epoprostenol and combination therapy. The prevalence of PHT significantly increased from 19.9% in 2005 to 37% in 2007. There was minimal benefit of treatment with PHT on pre-PTE mean pulmonary artery pressure, but its use was associated with a significant delay in time to referral for PTE. Both groups experienced significant improvements in hemodynamic parameters after PTE. The 2 groups did not differ significantly in any post-PTE outcome. Similar results were obtained for each subgroup.Conclusions-Our results suggest that PHT use has minimal effect on pre-PTE hemodynamics and no effect on post-PTE outcomes/hemodynamics. (Circulation. 2009; 120: 1248-1254.)