Pulmonary endarterectomy: Experience and lessons learned in 1,500 cases
Pulmonary endarterectomy: Experience and lessons learned in 1,500 cases
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DOI：
10.1016/s0003-4975(03)00828-2
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发表时间：
2003-11-01
影响因子：
4.6
通讯作者：
Auger, WR
中科院分区：
文献类型：
--
作者：
Jamieson, SW;Kapelanski, DP;Auger, WR
背景肺动脉慢性血栓性闭塞引起的肺动脉高压的发病率被大大低估。虽然药物治疗只能起到支持作用，但手术治疗是有效的。我们的肺动脉内膜切除术计划开始于1970年，并在随后的20年中有188例患者进行了手术。然而，随着对该病认识的提高和手术治疗的成功，自1990年以来，我们中心已进行了1,400多例手术。通过增加经验，评估手术的安全性和有效性。我们详细检查了最近500例连续患者的结果。正中胸骨切开术、心肺转流术、深低温和停循环被认为是手术成功的关键。术中可清除所有阻塞物。我们目前认为，肺血管树内没有任何程度的栓塞闭塞是不可接近的，也没有任何程度的右心室损害或任何水平的肺血管阻力是不可手术的。随着心脏骤停时间的缩短和头部冷却夹克的使用，脑损伤已经消除。本文对500例肺动脉高压患者的肺动脉压力和肺血管阻力进行了检测。手术死亡率稳步下降，最近500例手术患者中有22例（4.4%）。手术被认为是治愈性的，因此对于这种情况远远上级移植。目前的手术技术使手术相对安全。(C)2003年由胸外科医师协会发布。
Background. The incidence of pulmonary hypertension resulting from chronic thrombotic occlusion of the pulmonary arteries is significantly underestimated. Although medical therapy for the condition is supportive only, surgical therapy is curative. Our pulmonary endarterectomy program was begun in 1970, and 188 patients were operated on in the subsequent 20 years. With the increased recognition of the disease and the success of operative therapy, however, more than 1,400 operations have been done since 1990 at our center.Methods. The safety and efficacy of the operation was assessed with changes made through increased experience. We examined in detail the results of our last 500 consecutive patients.Results. Median sternotomy, cardiopulmonary bypass, profound hypothermia, and circulatory arrest were found to be essential to the success of the operation. All occluding material could be removed at operation. We currently believe that there is no degree of embolic occlusion within the pulmonary vascular tree that is inaccessible and no degree of right ventricular impairment or any level of pulmonary vascular resistance that is inoperable. With shorter cardiac arrest periods and the use of a cooling jacket to the head, cerebral impairment has been eliminated. The pulmonary artery pressures and pulmonary vascular resistance in a recent cohort of 500 patients is examined. The mortality rate for the operation has been reduced steadily, and was 22 of the last 500 patients operated on (4.4%).Conclusions. The operation is considered curative and therefore greatly superior to transplantation for this condition. Current techniques of operation make the procedure relatively safe. (C) 2003 by The Society of Thoracic Surgeons.