Impact of preoperative body mass index on long-term survival, quality of life, and functional outcomes after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: Results from the UK National Cohort.

Autor:	Chiu S; Division of Cardiac Surgery and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Illinois., Bunclark K; Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, United Kingdom., Appenzeller P; Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, United Kingdom., Ghani H; Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, United Kingdom., Taboada D; Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, United Kingdom., Sheares K; Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, United Kingdom., Toshner M; Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, United Kingdom., Pepke-Zaba J; Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, United Kingdom., Cannon J; Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, United Kingdom., Taghavi F; Department of Surgery, Royal Papworth Hospital, Cambridge, United Kingdom., Tsui S; Department of Surgery, Royal Papworth Hospital, Cambridge, United Kingdom., Ng C; Department of Surgery, Royal Papworth Hospital, Cambridge, United Kingdom., Jenkins DP; Department of Surgery, Royal Papworth Hospital, Cambridge, United Kingdom. Electronic address: david.jenkins1@nhs.net.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2024 Sep 10. Date of Electronic Publication: 2024 Sep 10.
DOI:	10.1016/j.healun.2024.09.005
Abstrakt:	Background: Previous studies have demonstrated the safety of pulmonary endarterectomy (PEA) across body mass index (BMI) strata. However, long-term survival and patient-reported outcome measures by BMI strata remain unknown. We examined the impact of preoperative BMI on long-term survival, QOL, and functional outcomes for patients undergoing PEA for chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Retrospective review of 2,004 patients from the UK National Cohort between 2007 and 2021 undergoing PEA for CTEPH (mean pulmonary artery pressure >20 mm Hg and pulmonary vascular resistance >160 dynes). Patients were stratified into BMI<20, 20 to 29, 30 to 39, 40 to 49, and 50+. All-cause mortality was the primary outcome measure. Secondary outcome measures were 3- to 6-month postoperative hemodynamics, 6-minute walk distance (6MWD), New York Heart Association (NYHA) class, and Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) scores. Results: Hemodynamics and 6MWD at 3 to 6 months were similar across BMI strata. Patients with BMI 50+ reported the highest incidence of postoperative NYHA III/IV limitation (53.3%, p < 0.001) and the highest residual symptom burden by CAMPHOR (p < 0.001). Five-year survival was lowest in patients with BMI 50+ (70.2%) and BMI<20 (73.4%), while highest in BMI 30 to 39 (88.2%, p = 0.008). Ten-year Kaplan-Meier estimates predicted the lowest survival in BMI 50+ and BMI<20. Conclusions: PEA remains safe and effective for all patients regardless of BMI. Despite similar hemodynamic outcomes, patients with BMI 50+ are at the greatest risk of long-term all-cause mortality, and patients with BMI 50+ experience residual symptomatic limitation. (Copyright © 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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