Long-term Outcome After Pulmonary Endarterectomy

Am J Respir Crit Care Med. 2008 Aug 15;178(4):419-24. doi: 10.1164/rccm.200801-101OC. Epub 2008 Jun 12.

Abstract

Rationale: There are few follow-up studies on long-term cardiopulmonary function after pulmonary endarterectomy (PEA), the operation of choice for chronic thromboembolic pulmonary hypertension (CTEPH).

Objectives: To prospectively evaluate long-term outcome of patients with CTEPH treated with PEA.

Methods: Between 1994 and 2006, 157 patients (mean age 55 yr) were treated with PEA at Pavia University Hospital. The patients were evaluated before PEA and at 3 months (n = 132), 1 year (n = 110), 2 years (n = 86), 3 years (n = 69), and 4 years (n = 49) afterward by NYHA class, right heart hemodynamic, spirometry, carbon monoxide transfer factor (Tl(CO)), arterial blood gas, and treadmill incremental exercise test.

Measurements and main results: Cumulative survival was 84%. Within 3 months, 18 patients died in-hospital and 2 had lung transplantation; during long-term follow-up, 6 died, 1 had lung transplantation, and 3 had a second PEA (2.5 events per 100 person-years). NYHA class III-IV was the most important predictor of late death, lung transplant, or PEA redo (hazard ratio, 3.94). Extraordinary improvement in NYHA class, hemodynamic, and Pa(O(2)) were achieved in the first 3 months (P < 0.001) and persisted during follow-up; exercise tolerance progressively increased over time (P < 0.001). At 4 years, although 74% of the patients were in NYHA class I and none was in class IV, 24% had pulmonary vascular resistance greater than 500 dyne.s/cm(5) or Pa(O(2)) less than 60 mm Hg; they were significantly older and were more frequently in NYHA class III-IV 3 months after surgery than the others.

Conclusions: After PEA, long-term survival and cardiopulmonary function recovery is excellent in most patients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Chronic Disease
  • Endarterectomy*
  • Exercise Test
  • Female
  • Fibromuscular Dysplasia / surgery*
  • Follow-Up Studies
  • Hemodynamics / physiology
  • Hospital Mortality
  • Humans
  • Hypertension, Pulmonary / surgery*
  • Male
  • Middle Aged
  • Oxygen / blood
  • Postoperative Complications / etiology*
  • Postoperative Complications / mortality
  • Postoperative Complications / physiopathology
  • Prospective Studies
  • Pulmonary Artery / surgery*
  • Pulmonary Diffusing Capacity / physiology
  • Pulmonary Embolism / surgery*
  • Pulmonary Gas Exchange / physiology
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / physiopathology
  • Spirometry
  • Survival Rate
  • Vascular Resistance / physiology
  • Ventricular Function, Right / physiology

Substances

  • Oxygen