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Risk factors for pulmonary thromboendarterectomy
P O Daily1, W P Dembitsky, S Iversen
1Sharp Memorial Hospital, San Diego, Calif.
The Journal of Thoracic and Cardiovascular Surgery
|April 1, 1990
Summary
Pulmonary thromboendarterectomy for chronic pulmonary embolism is effective but carries risks. Longer bypass times and inadequate pulmonary vascular resistance reduction increase ventilator dependency and mortality.
Area of Science:
- Cardiovascular Surgery
- Pulmonary Hypertension
- Thromboembolic Disease
Background:
- Pulmonary hypertension from chronic pulmonary embolism is increasingly treated with pulmonary thromboendarterectomy.
- Patient risk factors and procedural complications impacting outcomes require further definition.
Purpose of the Study:
- To identify patient-related risk factors and procedural complications associated with morbidity and mortality after pulmonary thromboendarterectomy.
Main Methods:
- A consecutive series of 127 patients undergoing pulmonary thromboendarterectomy with deep hypothermia and circulatory arrest were analyzed.
- Risk factors for ventilator dependency (≥5 days) and hospital mortality were assessed using univariate and multivariate analyses.
Main Results:
- Ventilator dependency occurred in 31.5% of patients; ascites and significant blood transfusion predicted this outcome.
- Hospital mortality was 12.6%. Increased cardiopulmonary bypass times predicted both ventilator dependency and mortality.
- Failure to reduce pulmonary vascular resistance by at least 50% strongly predicted hospital death.
Conclusions:
- Pulmonary thromboendarterectomy offers an acceptable mortality rate compared to heart-lung transplantation.
- Minimizing cardiopulmonary bypass time and ensuring adequate pulmonary vascular resistance reduction are crucial for improving outcomes.