Impact of residual pulmonary hypertension on long-term outcomes after pulmonary endarterectomy in the modern era.

Autor: Ishida K; Department of Cardiovascular Surgery Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Kohno H; Department of Cardiovascular Surgery Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Matsuura K; Department of Cardiovascular Surgery Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Sugiura T; Department of Respirology Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Sanada TJ; Department of Respirology Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Naito A; Department of Respirology Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Shigeta A; Department of Respirology Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Suda R; Department of Respirology Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Sekine A; Department of Respirology Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Masuda M; Department of Cardiovascular Surgery Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Sakao S; Department of Respirology Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Tanabe N; Department of Respirology Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Tatsumi K; Department of Respirology Chiba University Graduate School of Medicine Chiba Chiba-shi Japan., Matsumiya G; Department of Cardiovascular Surgery Chiba University Graduate School of Medicine Chiba Chiba-shi Japan.
Jazyk: angličtina
Zdroj: Pulmonary circulation [Pulm Circ] 2023 Apr 01; Vol. 13 (2), pp. e12215. Date of Electronic Publication: 2023 Apr 01 (Print Publication: 2023).
DOI: 10.1002/pul2.12215
Abstrakt: Residual pulmonary hypertension (PH) negatively impacts long-term results following pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). We sought to reveal whether modern PH therapy with PH-targeted medicine and balloon pulmonary angioplasty (BPA) improved long-term results of residual PH after PEA. Long-term findings of 80 patients who survived PEA between 2011 and 2019 were retrospectively investigated. One month after PEA, 30 patients developed residual PH defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg, of whom 23 were treated by PH-targeted medicine and 9 by BPA. Patients with residual PH acquired considerably better functional status and exercise capacity after PEA, however, exhibited significantly worse survival rates than those without. Eleven patients died during follow-up: 8 patients with residual PH and 3 controls. Among patients with residual PH, the deceased had a significantly lower %decrease in mPAP from 1 month to 1 year following PEA (7.4 [-32.6 to 8.0] % vs. 10.4 [3.7-27.8] %, p  = 0.03) and higher mPAP at 1 year following PEA (39.5 [33.25-42.5] vs. 27 [26-34] mmHg, p  < 0.01) despite PH-targeted medicine than the survived. No patients passed away from right heart failure, and there was no difference between the groups in CTEPH-related mortality. Modern PH therapy was used to address the majority of residual PH. Long-term survival after PEA was negatively impacted by residual PH, but it appeared that long-term mortality was also correlated with unrelieved residual PH despite PH-targeted medicine. Modern PH therapy may have enhanced functional status and excercise capacity, and averted fatal right heart failure.
Competing Interests: Takayuki J. Sanada belongs to departments endowed by Nippon Shinyaku Co. Ltd. Akira Naito has received research grant support from Bayer Yakuhin. Ayumi Sekine has received research grant support from Jansen Pharmaceutical K. K. and Nippon Shinyaku Co, Ltd. Nobuhiro Tanabe has received remuneration from Nippon Shinyaku, Janssen Pharmaceutical K. K., Bayer Yakuhin, and belongs to departments endowed by Janssen Pharmaceutical K. K. and Nippon Shinyaku. The remaining authors declare no conflict of interest.
(© 2023 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)
Databáze: MEDLINE
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