Resultados clínicos y hemodinámicos y factores de riesgo de mortalidad en pacientes sometidos a tromboendarterectomía pulmonar
| Autor: | Cristhian F. Ramirez-Ramos, Clara Saldarriaga-Giraldo, Manuela Yepes-Calderon, Gustavo Castilla-Agudelo, Mateo Aranzazu-Uribe, Santiago Saldarriaga-Betancur, Paulina Castro, Alejandro Londoño, Hector Ortega, Jorge Zapata- Sanchez, Eliana Cañas, Juan C. Rendon-Isaza |
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| Rok vydání: | 2021 |
| Předmět: |
Mechanical ventilation
medicine.medical_specialty Pulmonary thromboendarterectomy business.industry medicine.medical_treatment Hazard ratio Hemodynamics medicine.disease Pulmonary hypertension medicine.anatomical_structure medicine.artery Internal medicine Pulmonary artery medicine Vascular resistance Cardiology Cardiology and Cardiovascular Medicine business Cohort study |
| Zdroj: | Archivos de Cardiología de México. 92 |
| ISSN: | 1405-9940 |
| Popis: | BACKGROUND Pulmonary thromboendarterectomy is the current treatment of choice in patients with chronic thromboembolic pulmonary hypertension. The objective of the present study was to analyze the clinical and hemodynamic outcomes and the risk factors for mortality in a cardiovascular center in Colombia. METHODS Cohort study, conducted between 2001 and 2019. All operated patients were included in the study. Risk factors associated with mortality were established by means of a multivariate regression using the COX method and survival was established using the Kaplan-Meier method. p < 0.05 was considered statistically significant. RESULTS Seventy-three patients were operated. Median age was 51 years, 55% of females, 79% had functional Class III and IV. The mean pulmonary arterial pressure was 50 mmHg and 640 dyn.s.cm-5 for pulmonary vascular resistance (PVR). After the intervention, there was a decrease in mean pulmonary artery pressure (p ≤ 0.001) and in PVR (p = 0.357); 21% had evidence of residual pulmonary hypertension. Only 8% and 6% continued with functional Class III and IV at 6 and 12 months, respectively. There were 15 deaths (19.1%; 12% at 30 days). The factors associated with mortality were the diastolic diameter of the right ventricle measured postoperatively (hazard ratio [HR] 10.88 95% confidence interval [CI] 1.97-62, p = 0.007), time of invasive mechanical ventilation (HR 1.06 95% CI 1.02-1.09 p = 0.004), and the presence of complications during the surgical procedure (HR 5.62 95% CI 1.94-16.22 p = 0.001). CONCLUSIONS Pulmonary thromboendarterectomy is associated with excellent clinical and hemodynamic outcomes. The mortality risk factors found are not those usually described in the literature. |
| Databáze: | OpenAIRE |
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