| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1996;62:1255-1259
© 1996 The Society of Thoracic Surgeons
Department of Surgery, University of Illinois Hospital and Clinics, Chicago, Illinois
Background. The operative mortality associated with surgical thromboendarterectomy of the pulmonary arteries has decreased at the University of California in San Diego with the application of new techniques. For universal performance of the procedure, however, those factors that contribute to the high operative mortality must be identified. We analyzed our results in 34 consecutive patients undergoing pulmonary thromboendarterectomy to determine those preoperative factors that contribute to operative mortality.
Methods. Since 1983, 34 patients with severe, surgically correctable chronic thromboembolic pulmonary hypertension who were judged to be operable by pulmonary arteriography underwent pulmonary thromboendarterectomy. No patient was excluded because of right ventricular failure or hemodynamic severity of disease; the mean pulmonary artery pressure (PAP) was 54 mm Hg, the mean pulmonary vascular resistance (PVR) was 1,094 dynes•s•cm-5, and all patients were in New York Heart Association functional class III or IV.
Results. Postoperative course was characterized either by swift recovery (mean length of stay, 13 days) or by rapid demise resulting from pulmonary or right ventricular failure, or both (overall operative mortality, 23%). In survivors, the mean PAP, PVR, cardiac output, and New York Heart Association functional class were significantly improved (p < 0.05). Patients who died had a significantly greater mean preoperative PAP than did those who survived (62.1 ± 1.2 versus 49.5 ± 2.3 mm Hg; p < 0.01) and significantly higher PVR (1,512 ± 116 versus 949 ± 85 dynes •s • cm-5; p < 0.01). In addition, both a PVR of more than 1,100 dynes • s • cm-5 and a mean PAP of more than 50 mm Hg could accurately predict operative mortality: operative mortality was six times greater in patients with a preoperative PVR of greater than 1,100 dynes • s • cm-5 (41% versus 5.85%) and almost five times greater in those with a mean PAP of greater than 50 mm Hg (37% versus 8%). No intraoperative factors, including the use or duration of circulatory arrest, affected outcome.
Conclusions. Patients with severe hemodynamic disease (PVR >1,100 dynes • s • cm-5 and PAP >50 mm Hg) have a high likelihood of operative mortality and perhaps should not undergo pulmonary thromboendarterectomy, except at institutions where the operation is performed frequently.
Related Articles
Ann. Thorac. Surg. 1996 62: 1253-1254.
Ann. Thorac. Surg. 1996 62: 1259-1260.
This article has been cited by other articles:
|
|
 |
|
  P. M. Mikus, E. Mikus, S. Martin-Suarez, N. Galie, A. Manes, S. Pastore, and G. Arpesella Pulmonary endarterectomy: an alternative to circulatory arrest and deep hypothermia: mid-term results Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 159 - 163. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Ishida and M. Masuda Thromboendarterectomy for Severe Chronic Thromboembolic Pulmonary Hypertension Asian Cardiovasc Thorac Ann, June 1, 2007; 15(3): 229 - 233. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hardziyenka, H. J. Reesink, B. J. Bouma, H.A.C.M. R. de Bruin-Bon, M. E. Campian, M. W.T. Tanck, R. B.A. van den Brink, J. J. Kloek, H. L. Tan, and P. Bresser A novel echocardiographic predictor of in-hospital mortality and mid-term haemodynamic improvement after pulmonary endarterectomy for chronic thrombo-embolic pulmonary hypertension Eur. Heart J., April 1, 2007; 28(7): 842 - 849. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. D'Armini, G. Zanotti, S. Ghio, G. Magrini, M. Pozzi, L. Scelsi, G. Meloni, C. Klersy, and M. Vigano Reverse right ventricular remodeling after pulmonary endarterectomy J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 162 - 168. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Matsuda, H. Ogino, K. Minatoya, H. Sasaki, N. Nakanishi, S. Kyotani, J. Kobayashi, T. Yagihara, and S. Kitamura Long-term recovery of exercise ability after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ann. Thorac. Surg., October 1, 2006; 82(4): 1338 - 1343. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. A. Ghofrani, R. Voswinckel, F. Reichenberger, N. Weissmann, R. T. Schermuly, W. Seeger, and F. Grimminger Hypoxia- and non-hypoxia-related pulmonary hypertension - Established and new therapies Cardiovasc Res, October 1, 2006; 72(1): 30 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. H. S. Kim Assessment of Operability in Chronic Thromboembolic Pulmonary Hypertension Proceedings of the ATS, September 1, 2006; 3(7): 584 - 588. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Bresser, J. Pepke-Zaba, X. Jais, M. Humbert, and M. M. Hoeper Medical Therapies for Chronic Thromboembolic Pulmonary Hypertension: An Evolving Treatment Paradigm Proceedings of the ATS, September 1, 2006; 3(7): 594 - 600. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Rubin, M. M. Hoeper, W. Klepetko, N. Galie, I. M. Lang, and G. Simonneau Current and Future Management of Chronic Thromboembolic Pulmonary Hypertension: From Diagnosis to Treatment Responses Proceedings of the ATS, September 1, 2006; 3(7): 601 - 607. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Peacock, G. Simonneau, and L. Rubin Controversies, Uncertainties and Future Research on the Treatment of Chronic Thromboembolic Pulmonary Hypertension Proceedings of the ATS, September 1, 2006; 3(7): 608 - 614. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ogino, M. Ando, H. Matsuda, K. Minatoya, H. Sasaki, N. Nakanishi, S. Kyotani, H. Imanaka, and S. Kitamura Japanese Single-Center Experience of Surgery for Chronic Thromboembolic Pulmonary Hypertension Ann. Thorac. Surg., August 1, 2006; 82(2): 630 - 636. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Sato, M. Ando, A. Muto, Y. Kondo, R. Hoshino, T. Nishibe, and M. Yamashita Two cases of chronic pulmonary thromboembolism saved by postoperative use of a percutaneous cardiopulmonary support device. Ann. Thorac. Surg., July 1, 2006; 82(1): 314 - 316. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Langer, M. Bauer, D. Tscholl, R. Schramm, T. Kunihara, H. Lausberg, T. Georg, H. Wilkens, and H.-J. Schafers Circulating big endothelin-1: An active role in pulmonary thromboendarterectomy? J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1342 - 1347. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Puis, E. Vandezande, L. Vercaemst, P. Janssens, Y. Taverniers, M. Foulon, R. Demeyere, M. Delcroix, and W. Daenen Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension Perfusion, March 1, 2005; 20(2): 101 - 108. [Abstract] [PDF]
|
|
|
|
 |
|
 F. Langer, R. Schramm, M. Bauer, D. Tscholl, T. Kunihara, and H.-J. Schafers Cytokine Response to Pulmonary Thromboendarterectomy Chest, July 1, 2004; 126(1): 135 - 141. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Doyle, D. McCrory, R. N. Channick, G. Simonneau, and J. Conte Surgical Treatments/Interventions for Pulmonary Arterial Hypertension: ACCP Evidence-Based Clinical Practice Guidelines Chest, July 1, 2004; 126(1_suppl): 63S - 71S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Bresser, P.F. Fedullo, W.R. Auger, R.N. Channick, I.M. Robbins, K.M. Kerr, S.W. Jamieson, and L.J. Rubin Continuous intravenous epoprostenol for chronic thromboembolic pulmonary hypertension Eur. Respir. J., April 1, 2004; 23(4): 595 - 600. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Fadel, R. P. Michel, S. Eddahibi, R. Bernatchez, G.-M. Mazmanian, B. Baudet, P. Dartevelle, and P. Herve Regression of postobstructive vasculopathy after revascularization of chronically obstructed pulmonary artery J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1009 - 1017. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kitamura, T. Morota, and S. Takamoto Emergent pulmonary thromboendarterectomy with percutaneous cardiopulmonary support system for chronic thromboembolic pulmonary hypertension Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 656 - 658. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Kerr and L. J. Rubin Epoprostenol Therapy as a Bridge to Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension Chest, February 1, 2003; 123(2): 319 - 320. [Full Text] [PDF]
|
|
|
|
|
|
N. Nagaya, N. Sasaki, M. Ando, H. Ogino, F. Sakamaki, S. Kyotani, and N. Nakanishi Prostacyclin Therapy Before Pulmonary Thromboendarterectomy in Patients With Chronic Thromboembolic Pulmonary Hypertension Chest, February 1, 2003; 123(2): 338 - 343. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Thistlethwaite, M. Mo, M. M. Madani, R. Deutsch, D. Blanchard, D. P. Kapelanski, and S. W. Jamieson Operative classification of thromboembolic disease determines outcome after pulmonary endarterectomy J. Thorac. Cardiovasc. Surg., December 1, 2002; 124(6): 1203 - 1211. [Abstract] [Full Text]
|
|
|
|
|
|
T. Menzel, T. Kramm, S. Wagner, S. Mohr-Kahaly, E. Mayer, and J. Meyer Improvement of tricuspid regurgitation after pulmonary thromboendarterectomy Ann. Thorac. Surg., March 1, 2002; 73(3): 756 - 761. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. F. Fedullo, W. R. Auger, K. M. Kerr, and L. J. Rubin Chronic Thromboembolic Pulmonary Hypertension N. Engl. J. Med., November 15, 2001; 345(20): 1465 - 1472. [Full Text] [PDF]
|
|
|
|
|
|
D. Tscholl, F. Langer, O. Wendler, H. Wilkens, T. Georg, and H.-J. Schafers Pulmonary thromboendarterectomy - risk factors for early survival and hemodynamic improvement Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 771 - 776. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. D'Armini, B. Cattadori, C. Monterosso, C. Klersy, V. Emmi, F. Piovella, G. Minzioni, and M. Vigano Pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension: hemodynamic characteristics and changes Eur. J. Cardiothorac. Surg., December 1, 2000; 18(6): 696 - 702. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Menzel, S. Wagner, T. Kramm, S. Mohr-Kahaly, E. Mayer, S. Braeuninger, and J. Meyer Pathophysiology of Impaired Right and Left Ventricular Function in Chronic Embolic Pulmonary Hypertension : Changes After Pulmonary Thromboendarterectomy Chest, October 1, 2000; 118(4): 897 - 903. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Dartevelle, E. Fadel, A. Chapelier, P. Macchiarini, J. Cerrina, F. Parquin, F. Simonneau, and G. Simonneau Angioscopic video-assisted pulmonary endarterectomy for post-embolic pulmonary hypertension Eur. J. Cardiothorac. Surg., July 1, 1999; 16(1): 38 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. FADEL, G.-M. MAZMANIAN, A. CHAPELIER, B. BAUDET, H. DETRUIT, V. de MONTPREVILLE, J.-M. LIBERT, M. WARTSKI, P. HERVE, and P. DARTEVELLE Lung Reperfusion Injury after Chronic or Acute Unilateral Pulmonary Artery Occlusion Am. J. Respir. Crit. Care Med., April 1, 1998; 157(4): 1294 - 1300. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. K. Kolvekar, G. J. Peek, A. W. Sosnowski, R. K. Firmin, R. S. Hartz, and M. J. Davies Extracorporeal Membrane Oxygenator for Pulmonary Embolism Ann. Thorac. Surg., September 1, 1997; 64 (3): 883 - 884. [Full Text]
|
|
|
|
|
|
D. Shure Thromboendarterectomy: Some Unanswered Questions Ann. Thorac. Surg., November 1, 1996; 62(5): 1253 - 1254. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
