RT Journal Article
SR Electronic
T1 Surgical specimens, haemodynamics and long-term outcomes after pulmonary endarterectomy
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 116
OP 122
DO 10.1136/thoraxjnl-2013-203746
VO 69
IS 2
A1 Nika Skoro-Sajer
A1 Gabriel Marta
A1 Christian Gerges
A1 Gerald Hlavin
A1 Patrick Nierlich
A1 Shahrokh Taghavi
A1 Roela Sadushi-Kolici
A1 Walter Klepetko
A1 Irene Marthe Lang
YR 2014
UL http://thorax.bmj.com/content/69/2/116.abstract
AB Background Chronic thromboembolic pulmonary hypertension is surgically curable by pulmonary endarterectomy (PEA). It is unclear whether PEA impacts primarily steady state right ventricular afterload (ie, pulmonary vascular resistance (PVR)) or pulsatile right ventricular afterload (ie, pulmonary arterial compliance (CPA)). Our objectives were to (1) quantify PEA specimens and measure the impact of PEA on PVR and CPA in a structure/function study and (2) analyse the effects of haemodynamic changes on long-term survival/freedom of lung transplantation in an outcome study. Methods Thrombi were laid out, weighed, photographed and measured. PVR, CPA and resistance times compliance (RC-time) were assessed at baseline, within 4 days after PEA (‘immediately postoperative’) and 1 year after PEA, in 110 consecutive patients who were followed for 34.5 (11.9; 78.3) months. Results Lengths and numbers of PEA specimen tails were inversely correlated with immediate postoperative PVR (p<0.0001, r=−0.566; p<0.0001, r=−0.580). PVR and CPA normalised immediately postoperatively while RC-time remained unchanged. Immediate postoperative PVR was the only predictor of long-term survival/freedom of lung transplantation (p<0.0001). Patients with immediate postoperative PVR<590 dynes.s.cm−5 had better long-term outcomes than patients with PVR≥590 dynes.s.cm−5 (p<0.0001, respectively). Conclusions PEA immediately decreased PVR and increased CPA under a constant RC-time. However, immediate postoperative PVR was the only predictor of long-term survival/freedom of lung transplantation. Our study confirms the importance of a complete, bilateral surgical endarterectomy. Low PVR measured immediately postoperative predicts excellent long-term outcome.