PMID- 11113678
OWN - NLM
STAT- MEDLINE
DCOM- 20010208
LR  - 20190513
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 18
IP  - 6
DP  - 2000 Dec
TI  - Pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary 
      hypertension: hemodynamic characteristics and changes.
PG  - 696-701; discussion 701-2
AB  - OBJECTIVE: To see whether degree of pulmonary hypertension or severity of cardiac 
      failure affect the success of pulmonary thromboendarterectomy (PTE) in chronic 
      thromboembolic pulmonary hypertension. METHODS: From May 1996 to June 1999, 33 
      patients, all in New York Heart Association (NYHA) class 3 or 4 were treated with 
      PTE. Preoperative hemodynamic values were: central venous pressure (CVP) 8+/-6 
      (1-23), mean pulmonary artery pressure (mPAP) 50+/-10 (30-69), cardiac output 
      (CO) 3.3+/-0.9 (1.8-5.2), pulmonary vascular resistance (PVR) 1056+/-344 
      (523-1659), and right ventricle ejection fraction (RVEF) 12+/-5 (5-21). To 
      establish whether some hemodynamic or cardiac variables correlate with surgical 
      failure (early death or functional non-success), these patients were divided into 
      a low risk or a high risk group for each variable: CVP (<9 or > or =9), mPAP (<50 
      or > or =50), CO (> or =3.5 or <3.5), PVR (> or =1100 or <1100), and RVEF (> or = 
      10 or <10). The duration of 3-4 NYHA class period (<24 or > or = 24 months) was 
      also included in the study. RESULTS: Three patients (9. 1%) died in hospital, one 
      (3.0%) underwent lung transplant shortly after PTE, and in five cases (15.2%) 
      mPAP and PVR at the 3-month follow-up examination corresponded with our 
      definition of functional nonsuccess (mPAP and PVR decreased by less than 40% of 
      preoperative values). One of the five functional nonsuccess patients underwent 
      lung transplant 3 months after the operation and another died 17 months after the 
      operation from a non-related cause. Thus PTE was successful in 24 patients and 
      unsuccessful in nine. None of the hemodynamic variables considered was found to 
      be associated with the disparate outcomes. At the 3-month examination, all 
      surviving patients were in NYHA class 1 or 2 except for three in NYHA class 3. At 
      2 years, hemodynamic values were: CVP 2+/-2 (0-4), mPAP 16+/-3 (12-21), CO 
      5.0+/-1.0 (3.4-6.5), PVR 182+/-51 (112-282), and RVEF 35+/-5 (26-40). All 
      differences were significant with respect to baseline values (P<0.001). 
      Preoperative mPAP and RVEF values had a strict linear correlation (R=0.45; 
      P=0.014). CONCLUSIONS: None of the variables considered was correlated with early 
      death or functional nonsuccess. Neither preoperative severity of pulmonary 
      hypertension nor degree of cardiac failure influenced the outcome of the 
      operation. PTE leads to hemodynamic recovery even in very compromised patients.
FAU - D'Armini, A M
AU  - D'Armini AM
AD  - Division of Cardiac Surgery, San Matteo Hospital, University of Pavia (Divisione 
      di Cardiochirurgia, I.R.C.C.S. Policlinico San Matteo, Universita di Pavia), 
      Piazzale Golgi 2, 27100, Pavia, Italy. darmini@smatteo.pv.it
FAU - Cattadori, B
AU  - Cattadori B
FAU - Monterosso, C
AU  - Monterosso C
FAU - Klersy, C
AU  - Klersy C
FAU - Emmi, V
AU  - Emmi V
FAU - Piovella, F
AU  - Piovella F
FAU - Minzioni, G
AU  - Minzioni G
FAU - Vigano, M
AU  - Vigano M
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Adult
MH  - Chronic Disease
MH  - *Endarterectomy/methods/statistics & numerical data
MH  - Female
MH  - Hemodynamics
MH  - Humans
MH  - Hypertension, Pulmonary/etiology/physiopathology/*surgery
MH  - Lung Transplantation
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Patient Selection
MH  - Pulmonary Embolism/complications/physiopathology/*surgery
MH  - Risk Factors
MH  - Statistics, Nonparametric
MH  - Time Factors
MH  - Treatment Failure
EDAT- 2000/12/13 11:00
MHDA- 2001/03/03 10:01
CRDT- 2000/12/13 11:00
PHST- 2000/12/13 11:00 [pubmed]
PHST- 2001/03/03 10:01 [medline]
PHST- 2000/12/13 11:00 [entrez]
AID - S1010794000005844 [pii]
AID - 10.1016/s1010-7940(00)00584-4 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2000 Dec;18(6):696-701; discussion 701-2. doi: 
      10.1016/s1010-7940(00)00584-4.