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

Read at the 90th Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, May 1–5, 2010.
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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.

CTSNet classification

11

Abbreviations and Acronyms

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

Cited by (0)

Grant support: This registry was supported by Actelion Pharmaceuticals Ltd.

Disclosures: E. Mayer has received fees for consulting or serving on advisory boards and lecture fees from Bayer-Schering and Actelion Pharmaceuticals Ltd. D. Jenkins has received fees for consulting or serving on advisory boards from Bayer. J. Lindner has received fees for consulting or serving on advisory boards from Bayer-Schering and lecture fees from Actelion Pharmaceuticals Ltd. A. M. D'Armini has received fees for consulting or serving on advisory boards from Pfizer and lecture fees from Actelion Pharmaceuticals Ltd. B. Meyns has received lecture fees from Circulite and Abiomed. L. B. Ilkjaer has received fees for consulting or serving on advisory boards from Bayer Health Care. W. Klepetko has received fees for consulting or serving on advisory boards from Astellas. M. Delcroix has received fees for consulting or serving on advisory boards from Actelion Pharmaceuticals Ltd and GlaxoSmithKline, and lecture fees from Pfizer and LungRx. I. Lang has received fees for consulting or serving on advisory boards and lecture fees from Actelion Pharmaceuticals Ltd, Pfizer, AOP Orphan Pharmaceutivals AG, Bayer, GlaxoSmithKline. J. Pepke-Zaba has received lecture fees from Actelion Pharmaceuticals Ltd, Pfizer, and Bayer. P. Dartevelle has nothing to disclose with regard to commercial support.

The CTEPH Registry is owned and managed by the Association for Research in CTEPH. The Association is headed by an Executive Board, composed of CTEPH experts. The Executive Board of the Association provided expert opinion on the registry design, CTEPH medical issues, and input into the analyses and publications.