Do Right Heart Hemodynamic Improvements Persist After Pulmonary Thromboendarterectomy?
| Autor: | Brian D. Lahr, Sudhir S. Kushwaha, David L. Joyce, Courtney N. Day, Gurpreet S. Sandhu, Michael T. Cain, Lyle D. Joyce |
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| Rok vydání: | 2022 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Haemodynamic response Hypertension Pulmonary medicine.medical_treatment Hemodynamics Endarterectomy 030204 cardiovascular system & hematology Single Center law.invention 03 medical and health sciences 0302 clinical medicine law Internal medicine medicine Cardiopulmonary bypass Humans Pulmonary thromboendarterectomy business.industry General Medicine Tricuspid Valve Insufficiency Right Ventricular Assist Device Treatment Outcome 030228 respiratory system Chronic Disease Right heart Ventricular pressure Cardiology Surgery Pulmonary Embolism Cardiology and Cardiovascular Medicine business |
| Zdroj: | Seminars in Thoracic and Cardiovascular Surgery. 34:80-89 |
| ISSN: | 1043-0679 |
| DOI: | 10.1053/j.semtcvs.2021.03.002 |
| Popis: | The survival benefits of pulmonary thromboendarterectomy (PTE) for the treatment of chronic thromboembolic pulmonary hypertension have been well described. However, the significance of right heart hemodynamic changes and their impact on survival remains poorly understood. We sought to characterize the effects of these changes. We conducted a single center, retrospective review of 159 patients who underwent PTE between 1993 and 2015. Echocardiographic and right heart catheterization data were compared longitudinally before and after PTE in order to establish the extent of hemodynamic response to surgery. Kaplan Meier estimates were used to characterize patient survival over time. Univariable and multivariable Cox proportional hazards regression models were used to assess factors associated with long-term mortality. Among the 159 patients studied, 74 (46.5%) were male with a median age of 55 (IQR: 42-66). One-, 5-, 10-, and 15-year survival was 91.0% (95% CI: 86.6-95.6), 79.6% (73.5-86.3), 66.5% (59.2-74.7), and 56.2% (48.1-65.8). Of the 9 candidate risk factors that were evaluated, only advanced age and increased cardiopulmonary bypass time were found to be significantly associated with increased risk of mortality. Pre- and postsurgical echocardiographic imaging data, when available, revealed a median reduction in right ventricular systolic pressure of 29.0 mm Hg (P0.0001) and improvement of tricuspid regurgitation (P0.0001), both of which appeared to be sustained across long-term follow-up. Improvements in right heart hemodynamics and tricuspid valvular regurgitation persist on long term surveillance following PTE. While patient selection is often driven by the distribution of disease, close postoperative follow up may improve outcomes. |
| Databáze: | OpenAIRE |
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