Long-term changes of exercise hemodynamics and physical capacity in chronic thromboembolic pulmonary hypertension after pulmonary thromboendarterectomy

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and life-threatening condition with poor prognosis in patients with antiphospholipid syndrome (APS). Pulmonary thromboendarterectomy (PTE) is the optimal surgical option for CTEPH. Objectives This retrospective cohort study aimed to evaluate the efficacy and risk of PTE in patients with APS-associated CTEPH. Methods Consecutive patients with APS-associated CTEPH diagnosed between January 2012 and September 2017 at Peking Union Medical College Hospital were retrospectively evaluated. Demographics, clinical manifestations, antiphospholipid antibody (aPL) profiles, and pulmonary arterial hypertension–targeted medications were collected. Deterioration of cardiac function and death were chosen as the endpoints, in order to assess the effect of PTE on short-term and long-term prognoses (evaluated by the change of cardiac function after treatment and cardiac deterioration or death in the follow-up, respectively). Results A total of 20 patients with APS-associated CTEPH were enrolled, and eight patients underwent PTE. Chi-square test ( p = 0.01) and Kaplan–Meier curves (log rank test, p = 0.04) showed that there were statistically significant differences in both short-term and long-term prognoses between patients with and without PTE. Conclusion These results provide strong evidence that PTE is a curative resolution in patients with APS-associated CTEPH. Following a full specialized and multidisciplinary risk-benefit evaluation to limit the risk of thrombosis or bleeding and to manage possible thrombocytopenia, PTE is at least a temporal curative resolution for CTEPH complicated with APS.

Download Full-text

Surgical Treatment of Chronic Thromboembolic Pulmonary Hypertension

Advances in Pulmonary Hypertension ◽

10.21693/1933-088x-6.2.83 ◽

2007 ◽

Vol 6 (2) ◽

pp. 83-91

Author(s):

Michael M. Madani ◽

Stuart W. Jamieson

Keyword(s):

Pulmonary Hypertension ◽

Medical Management ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Thromboembolic Disease ◽

Definitive Treatment ◽

Pulmonary Vasculature ◽

Pulmonary Thromboendarterectomy ◽

Thromboembolic Pulmonary Hypertension ◽

Long Term Prognosis

Pulmonary hypertension as the result of chronic pulmonary thromboembolic disease is a serious condition with poor long-term prognosis. The condition is one of the more common cardiovascular diseases affecting Americans, yet it is severely underdiagnosed. Pulmonary thromboendarterectomy is the definitive treatment for chronic pulmonary hyper-tension as the result of thromboembolic disease; however. it is an uncommon procedure, primarily because of lack of recognition on the part of the clinicians. Patients affected by chronic thromboembolic pulmonary hypertension (CTEPH) may present with a variety of debilitating cardiopulmonary symptoms. However, once diagnosed, there is no curative role for medical management, and surgery remains the only option. Palliation therapy with medical management in order to delay surgery carries the risk of prolonging the disease and irreversibly damaging unaffected pulmonary vasculature.

Download Full-text

P4670Long-term changes of exercise haemodynamics and physical capacity in chronic thromboembolic pulmonary hypertension after pulmonary thromboendarterectomy

European Heart Journal ◽

10.1093/eurheartj/ehz745.1052 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

F Waziri ◽

S Mellemkjaer ◽

T S Clemmensen ◽

V E Hjortdal ◽

L B Ilkjaer ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Cardiac Output ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Peak Oxygen Uptake ◽

Physical Capacity ◽

Peak Exercise ◽

Healthy Controls ◽

Pulmonary Thromboendarterectomy ◽

Right Heart Catheterisation ◽

Thromboembolic Pulmonary Hypertension

Abstract Background A substantial number of chronic thromboembolic pulmonary hypertension (CTEPH) patients experience dyspnoea on exertion and limited exercise capacity despite surgically successful pulmonary endarterectomy (PEA). Purpose We sought to prospectively evaluate resting and peak exercise haemodynamics before, 3 and 12 months after PEA in consecutive CTEPH patients and correlate it to physical functional capacity. Methods Twenty CTEPH patients who underwent PEA treatment were examined between December 2014 and January 2017. The patients were examined pre-operatively and 3 and 12 months post-operatively with right heart catheterisation at rest and during a maximal symptom-limited, semi-supine cardiopulmonary exercise test. Finally, the data were compared with 15 healthy controls who had previously undergone the same protocol. Results Twelve months after PEA, 75% of patients with severely increased pre-PEA mean pulmonary arterial pressure (mPAP) at rest had normal or mildly increased mPAP. However, mPAP reduction was less pronounced during exercise where only 45% had normal or mildly increased mPAP at 12 months. Cardiac output (CO) reserve (CO increase from rest to peak exercise) was increased (5.7±2.9 L/min) 12 months after PEA compared with pre-PEA (2.5±1.8 L/min), p<0.0001. However, 12 months after PEA, the CO reserve was only 49% of that of healthy controls, p<0.0001. Changes in cardiac output (ΔCO), calculated as the difference between CO before PEA and 12 months later, were significantly correlated with six-minute-walk-test and peak oxygen uptake (VO2), both at rest and peak exercise. Figure 1 Conclusion Invasive exercise haemodynamic examination in CTEPH patients demonstrates that after otherwise successful PEA surgery, more than 50% of patients have a significant increase in exercise mPAP, and the CO reserve remains compromised 12 months after PEA. Improvement in physical capacity is correlated with ΔCO. Acknowledgement/Funding Danish Heart Foundation, Aarhus University, Arvid Nilssons Fond, Eva & Henry Frænkels Mindefond, and Snedkermester Sophus Hustru Astrid Jacobsens Fond

Download Full-text

Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239700500108 ◽

1997 ◽

Vol 5 (1) ◽

pp. 35-38

Author(s):

Gao Chang Qing ◽

Rodolfo Barragan Garcia

Keyword(s):

Pulmonary Hypertension ◽

Median Sternotomy ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Pulmonary Thromboendarterectomy ◽

Pulmonary Hemodynamic ◽

Major Vessel ◽

Thromboembolic Pulmonary Hypertension ◽

Hemodynamic Improvement

We describe our experience of treating chronic major vessel thromboembolic pulmonary hypertension with pulmonary thromboendarterectomy. Thromboendarterectomy was performed in 15 patients through a median sternotomy incision using extracorporeal circulation and deep hypothermia. Postoperatively mean pulmonary artery pressure, mean pulmonary vascular resistance, and cardiac index were significantly improved (p < 0.001). Four patients died during surgery, mainly from perfusion edema (operative mortality 27%). The 11 surviving patients received long-term anticoagulant therapy and no incidence of thromboembolism has occurred during the follow-up period. All have shown sustained pulmonary hemodynamic improvement; however, there were 2 late deaths from cardiac failure. We conclude that thromboendarterectomy is an effective treatment for chronic major vessel thromboembolic pulmonary hypertension.

Download Full-text

Pulmonary Endarterectomy: Assessment of Operability, Surgical Description, and Post-op Care

Advances in Pulmonary Hypertension ◽

10.21693/1933-088x-12.4.186 ◽

2014 ◽

Vol 12 (4) ◽

pp. 186-192 ◽

Cited By ~ 1

Author(s):

David Poch ◽

Victor Pretorius

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Pulmonary Arteries ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Pulmonary Artery Wedge Pressure ◽

Pulmonary Endarterectomy ◽

Pulmonary Thromboendarterectomy ◽

Thromboembolic Pulmonary Hypertension ◽

Wedge Pressure

Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a mean pulmonary artery pressure ≥25 mm Hg and pulmonary artery wedge pressure ≤15 mm Hg in the presence of occlusive thrombi within the pulmonary arteries. Surgical pulmonary thromboendarterectomy (PTE) is considered the best treatment option for CTEPH.

Download Full-text