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Pavia Experience in Reoperative Pulmonary Endarterectomy
Vera Nadia Merli1, Nicola Vistarini1, Valentina Grazioli1
1Department of Cardio-Thoracic and Vascular Surgery, Foundation "I.R.C.C.S. Policlinico San Matteo," University of Pavia, School of Medicine, Pavia, Italy.
Seminars in Thoracic and Cardiovascular Surgery
|September 23, 2017
Summary
Redo pulmonary endarterectomy (PEA) offers hemodynamic benefits but carries a high mortality risk. Careful patient selection is crucial for repeat PEA, favoring younger patients with no other risk factors.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pulmonary Hypertension
Background:
- Pulmonary endarterectomy (PEA) is a primary treatment for chronic thromboembolic pulmonary hypertension (CTEPH).
- Recurrence of symptomatic disease after initial PEA necessitates re-evaluation of treatment options.
Purpose of the Study:
- To investigate the causes of symptomatic recurrence after PEA.
- To evaluate the clinical and hemodynamic outcomes of repeat PEA.
- To assess the in-hospital mortality associated with redo PEA.
Main Methods:
- Retrospective analysis of 10 patients who underwent a second PEA between 1994 and 2016.
- Comparison of pre- and post-operative hemodynamic data (mean pulmonary arterial pressure, pulmonary vascular resistance).
- Evaluation of World Health Organization (WHO) functional class and in-hospital mortality.
Main Results:
- Redo PEA significantly reduced mean pulmonary arterial pressure (45 to 34 mm Hg) and pulmonary vascular resistance (932 to 428 dyne*s*cm⁻⁵).
- Patients showed improvement in WHO functional class post-redo surgery.
- The in-hospital mortality rate for repeat PEA was high at 40%.
Conclusions:
- Repeat PEA can yield favorable hemodynamic and clinical results, though less pronounced than after the first surgery.
- High mortality risk necessitates careful consideration of redo PEA candidacy.
- Younger patients without comorbidities and recent pulmonary hypertension are better candidates; otherwise, medical therapy or interventional approaches should be considered.
