Survival after pulmonary thromboendarterectomy: Effect of residual pulmonary hypertension
Survival after pulmonary thromboendarterectomy: Effect of residual pulmonary hypertension
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DOI：
10.1016/j.jtcvs.2009.12.056
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发表时间：
2011-02-01
影响因子：
6
通讯作者：
Jenkins, David P.
中科院分区：
文献类型：
--
作者：
Freed, Darren H.;Thomson, Bruce M.;Jenkins, David P.
目的：肺动脉内膜切除术是慢性血栓栓塞性肺动脉高压的首选治疗方法。在许多患者中，血流动力学在手术干预后早期恢复正常。然而，残余肺动脉高压对术后临床状态和生存率的影响尚不清楚。方法：前瞻性收集了1997年至2007年12月在全国连续系列中接受肺动脉内膜切除术的所有患者的数据。术后3个月，患者接受了计划的再检查，包括功能检查和右心导管插入术。他们被分为2组的基础上平均肺动脉压：组1，小于30毫米汞柱;组2，30毫米汞柱或great.Results：314例患者进行肺动脉内膜切除术，存活出院，并完成了3个月的随访期。在肺动脉内膜切除术后3个月，整个队列的平均肺动脉压显著降低（48 +/-12至26 +/-10 mm Hg，P <0.001）。然而，31%的患者有残余肺动脉高压。与第2组患者相比，第1组患者的运动能力和症状改善明显更好。此外，第1组接受靶向药物治疗的患者明显少于第2组（0% vs 25%，P <.001）。整个队列出院后5年的条件生存率为90.0%，两组之间无差异（第1组为90.3%，第2组为89.9%，P = 0.36）。结论：对于接受肺动脉内膜切除术的患者，出院后的生存率非常高。残余肺动脉高压明显损害症状状态和功能能力，但似乎没有对中期生存率产生不利影响。肺动脉内膜剥脱术后残余肺动脉高压患者的靶向药物治疗效果有待进一步评价。（《胸血管外科杂志》2011; 141：383 - 7）
Objective: Pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension. In many patients hemodynamics are normalized early after surgical intervention. However, the effect of residual pulmonary hypertension on postoperative clinical status and survival is unknown.Methods: Data were collected prospectively on all patients who underwent pulmonary endarterectomy in a continuous national series between 1997 and December 2007. Postoperatively, patients underwent scheduled reinvestigation, including functional testing and right heart catheterization, at 3 months after the operation. They were divided into 2 groups based on mean pulmonary artery pressure: group 1, less than 30 mm Hg; group 2, 30 mm Hg or greater.Results: Three hundred fourteen patients underwent pulmonary endarterectomy, survived to hospital discharge, and completed the 3-month follow-up period. At 3 months after pulmonary endarterectomy, there was a significant reduction in mean pulmonary artery pressure for the whole cohort (48 +/- 12 to 26 +/- 10 mm Hg, P < .001). However, 31% of the patients had residual pulmonary hypertension. Group 1 patients enjoyed significantly better exercise capacity and improved symptoms compared with group 2 patients. In addition, there were significantly fewer patients receiving targeted medical therapy in group 1 versus group 2 (0% vs 25%, P < .001). Conditional survival after discharge from the hospital for the whole cohort was 90.0% at 5 years and was not different between groups (90.3% for group 1 vs 89.9% for group 2, P = .36).Conclusions: For patients undergoing pulmonary endarterectomy, survival after hospital discharge is excellent. Residual pulmonary hypertension significantly compromised symptom status and functional capacity but did not appear to adversely affect medium-term survival. The effect of targeted medical therapy in patients with residual pulmonary hypertension after pulmonary endarterectomy needs to be evaluated further. (J Thorac Cardiovasc Surg 2011;141:383-7)