Haemodynamic benefit of bridging use of bosentan prior to pulmonary endarterectomy.
Haemodynamic benefit of bridging use of bosentan prior to pulmonary endarterectomy.
复制标题
肺动脉内膜切除术之前桥接使用波生坦的血流动力学益处。
DOI：
10.1093/ejcts/ezab137
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发表时间：
2021
影响因子：
3.4
通讯作者：
Schテ、fers HJ.
中科院分区：
文献类型：
--
作者：
Kunihara T;Wilkens H;Halank M;Held M;Nomura R;Igarashi T;Sata F;Schテ、fers HJ.
目的部分患者因慢性血栓栓塞性肺动脉高压(CTEPH)行肺内膜切除术(PEA)前存在过度的肺动脉高压(PH)。方法将2003~2017年间首次行PEA的370例CTEPH患者分为两组，分别给予波生坦(B组，n=119)和非靶向PH预处理(C组，n=251)。在选择服用波生坦(2-8个 月)的患者并使用倾向评分匹配后，从两组中创建可比较的患者队列(n=23)。结果两组配对前后围术期人口学特征及30d病死率差异无统计学意义(5.7%)。在术前肺血管阻力≥800dynes S/cm5的患者中，B组肺血管阻力下降(78%)明显高于C组(68%)(P=0.033)。配型后两组患者的晚期存活率差异无统计学意义。B组残余/持续性PH(平均肺动脉压<25 )的发生率低于C组(分别为22%和39%，P=0.200)。高龄和较长体外循环时间是影响术后30d病死率和残余/持续性肺高压的独立预测因素(优势比：年龄分别为1.053、1.013，体外循环时间分别为1.065、1.010)。结论波生坦治疗2~8个月可改善 高危患者术后PVR，且无不良临床事件发生。在PEA前，临时过渡方案似乎对选定的患者是有益的。
OBJECTIVESSome patients present with excessive pulmonary hypertension (PH) prior to pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). This study was performed to evaluate the clinical role of pretreatment before PEA in CTEPH patients.METHODSA total of 370 patients with CTEPH undergoing first PEA between 2003 and 2017 were divided into those receiving pretreatment with bosentan (group B:n=119) and those without targeted pretreatment for PH (group C:n=251). After selecting patients given bosentan (2–8 months) and using propensity score matching, comparable patient cohorts (n=23 each) were created from both groups. PEA was performed in the standard manner, and the median number of extracted segments was 14.RESULTSThere were no significant differences in perioperative demographic characteristics or 30-day mortality (overall 5.7%) between the groups before and after matching. In patients with preoperative pulmonary vascular resistance (PVR) ≥800 dynes s/cm5, a significantly larger decrease in PVR was found in group B (78%) compared to group C (68%) (P=0.033). There was no significant difference in late survival between the groups after matching. The frequency of residual/persistent PH (mean pulmonary artery pressure >25 mmHg) was lower in group B than in group C, although the difference was not significant (22% vs 39%, respectively,P=0.200). Advanced age and longer cardiopulmonary bypass time were independent predictors of both 30-day mortality and residual/persistent PH (odds ratio: age, 1.053, 1.013, cardiopulmonary bypass time, 1.065, 1.010, respectively).CONCLUSIONSPreoperative treatment of CTEPH patients with bosentan for 2–8 months can improve post-PEA PVR without adverse clinical events in patients with a high preoperative PVR. A temporary bridging regime appears beneficial in selected patients prior to PEA.