Objective: To determine whether preoperative systemic inflammation (defined by C-reactive protein [CRP] levels ≥10 mg/L) is associated with worse functional and hemodynamic status and poor early outcomes postendarterectomy in patients with chronic thromboembolic pulmonary hypertension (CTEPH).
Methods: This study included 159 patients who underwent pulmonary endarterectomy from 2009 to 2013 (derivation cohort) and 238 patients from 2015 to 2016 (validation cohort) with CRP data from the national CTEPH registry. The correlations between proinflammatory markers (CRP, interleukins 1 and 6, fibrinogen, and leukocytes) and hemodynamics were assessed in the derivation cohort. Pre-, perioperative characteristics, and 30-day outcomes (ie, death or lung transplant or extracorporeal membrane oxygenation need or inotropic or vasopressor need ≥3 days) of patients with CRP levels ≥ or <10 mg/L were compared.
Results: Median age of the derivation cohort was 63 [52-73] years with 48% female, 80% in New York Heart Association class III/IV. The validation cohort had similar demographics and disease severity. Patients with CRP ≥10 mg/L had greater resistance levels and lower cardiac index than those with CRP <10 mg/L in both cohorts. The primary endpoint was reached in 38% (derivation) and 42% (validation) of patients. In multivariable logistic regression analysis, CRP ≥10 mg/L was associated with the primary endpoint in both the derivation cohort (odd ratio, 2.49 [1.11-5.61], independently of New York Heart class class IV and aortic clamping duration) and the validation cohort (odd ratio, 1.89 [1.09-3.61], independently of age and aortic clamping duration).
Conclusions: Preoperative CRP ≥10 mg/L is independently associated with adverse early outcomes postendarterectomy.
Keywords: chronic thromboembolic pulmonary hypertension; endarterectomy; inflammation; outcomes; pulmonary hypertension.
Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Plasma levels of high density lipoprotein cholesterol and outcomes in chronic thromboembolic pulmonary hypertension.PLoS One. 2018 May 29;13(5):e0197700. doi: 10.1371/journal.pone.0197700. eCollection 2018. PLoS One. 2018. PMID: 29813091 Free PMC article.
Outcome after surgical treatment of chronic thromboembolic pulmonary hypertension: dealing with different patient subsets. A single-centre experience.Eur J Cardiothorac Surg. 2016 Nov;50(5):898-906. doi: 10.1093/ejcts/ezw099. Epub 2016 Apr 12. Eur J Cardiothorac Surg. 2016. PMID: 27072006
Obstructive sleep apnea in patients with chronic thromboembolic pulmonary hypertension.J Thorac Dis. 2018 Oct;10(10):5804-5812. doi: 10.21037/jtd.2018.09.118. J Thorac Dis. 2018. PMID: 30505488 Free PMC article.
Recent advances of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension including Japanese experiences.Gen Thorac Cardiovasc Surg. 2014 Jan;62(1):9-18. doi: 10.1007/s11748-013-0323-4. Epub 2013 Sep 26. Gen Thorac Cardiovasc Surg. 2014. PMID: 24068659 Review.
Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension : a systematic review.Ann Thorac Cardiovasc Surg. 2011;17(5):435-45. doi: 10.5761/atcs.oa.10.01653. Epub 2011 Jul 13. Ann Thorac Cardiovasc Surg. 2011. PMID: 21881372 Review.