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15-Year Outcomes after Pulmonary Endarterectomy


  • #CH/ADU 01-O-7
  • Congenital Heart Surgery/Adult Congenital Cardiac. SESSION-1
  • Oral

15-Year Outcomes after Pulmonary Endarterectomy

Alexander Chernyavskiy, Alexander Edemskiy, Natalya Novikova, Elena Kliver

E.Meshalkin NMRC, Novosibirsk, Russia

Date, time and location: 2018.05.26 17:00, Press Hall, 2F

Abstract

Background. Pulmonaryendarterectomy(PEA) is the treatment of choice for patients with chronic thromboembolicpulmonaryhypertension (CTEPH). The true incidence of CTEPH remains unknown. We present 10-year outcomes of surgical treatment in patients with CTEPH.

Methods.Between 2004 and 2017 282 patients underwent PEA for CTEPH. 10-year outcomes after surgery were assessed in 179 (63.5%) patients. These patients underwent clinical (6MWD, Borg scale, SF-36 questionnaire) and instrumental evaluation (echocardiography, VQ-scintigraphy, right heart catheterization).

Results.Mean patient age at surgery was 48.5 [40.5;57.25] years. 6MWD increased from 200 [197;202] m before surgery to 453 [440;460] m in long-term follow-up, (p<0.001). Borg scale index decreased from 7 [6;8] to 1 [1;2], (p<0.001). There was a significant reduction in meanpulmonarypressure from 37 [32;40] to 29 [28;31] mmHg (p<0.001) and pulmonary vascular resistance from 830 [621.2; 1380] to 510 [482; 682]dyn·sec·cm-5(p=0.021) in long-term follow-up. Residual pulmonary hypertension in long-term follow-up was registered in 51 (18%) patients. We also noticed significant elevation of cardiac output from 3.68 [2.8;4.1] to 4 [3.2;4.4] l/min in the whole group (p<0.001). According to VQ-scintigraphy we noticed statistically significant reduction of lung perfusion deficit from 43.4% [37.85;41.9] to 10.8% [10.9;12.3], (p<0.001). Overall mortality was in 23 (8.3%) cases. There were 15 in-hospital deaths (5.3%) due to reperfusion pulmonary edema (n=8), multiorgan failure (n=3) and pulmonary bleeding (n=4). In 10-years follow-up period mortality was registered in 7 (2.4%) cases due to residual pulmonary hypertension and progressive right hear failure.

Conclusions:Despite the increased perioperative risk and mortality PEA should be considered to patients with CTEPH as the first treatment option. Keeping increased perioperative risk and mortality in mind, significant pressure reduction and improved functional outcome can be achieved in the majority of these patients with rather low rate of residual pulmonary hypertension.


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