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Factors predicting outcome after pulmonary endarterectomy
Cécile Tromeur1,2,3, Xavier Jaïs4,5,6, Olaf Mercier4,6,7
1European Brittany University, Brest, France.
Plos One
|June 22, 2018
Summary
Pulmonary endarterectomy (PEA) improves patient outcomes in chronic thromboembolic pulmonary hypertension. Preoperative factors like pulmonary vascular resistance (PVR), cardiac output (CO), and carbon monoxide transfer factor (TLCO) predict mortality and hemodynamic success.
Area of Science:
- Cardiology
- Pulmonology
- Vascular Surgery
Background:
- Pulmonary endarterectomy (PEA) is a critical treatment for chronic thromboembolic pulmonary hypertension (CTEPH).
- Predictive factors for mortality and hemodynamic improvement post-PEA remain incompletely understood.
Purpose of the Study:
- To identify preoperative factors influencing mortality after PEA.
- To determine predictors of hemodynamic improvement following PEA.
Main Methods:
- Retrospective review of 383 consecutive PEA patients (2005-2009).
- 150 patients underwent detailed reevaluation including NYHA class, 6-minute walk distance (6MWD), carbon monoxide transfer factor (TLCO), and right heart catheterization.
- Analysis of mortality rates at 1 month, 1 year, and 3 years.
Main Results:
- Overall mortality rates were 2.8% (1 month), 6.9% (1 year), and 7.5% (3 years).
- Preoperative pulmonary vascular resistance (PVR) and age predicted mortality.
- Significant improvements in NYHA class and 6MWD were observed; PVR decreased significantly (773 to 307 dyn.sec.cm-5).
- Preoperative cardiac output (CO) and TLCO predicted hemodynamic improvement.
Conclusions:
- PEA offers excellent long-term survival and significant clinical and hemodynamic benefits.
- Preoperative PVR, CO, and TLCO are valuable predictors of postoperative outcomes in CTEPH patients undergoing PEA.
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