PMID- 11404129
OWN - NLM
STAT- MEDLINE
DCOM- 20010920
LR  - 20190513
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 19
IP  - 6
DP  - 2001 Jun
TI  - Pulmonary thromboendarterectomy--risk factors for early survival and hemodynamic 
      improvement.
PG  - 771-6
AB  - OBJECTIVE: Pulmonary thromboendarterectomy (PTE) for chronic thromboembolic 
      pulmonary hypertension is a challenging procedure with a considerable mortality. 
      The aim of this investigation was to identify risk factors influencing mortality 
      and operative results. METHODS: Between October 1995 and August 2000, 69 patients 
      (age 54 years; 34 women; mean New York Heart Association (NYHA) stage 3.4) 
      underwent PTE. The preoperative pulmonary vascular resistance (PVR) was 988+/-554 
      dynes x s x cm(-5), mean pulmonary artery pressure 50+/-12 mmHg, right atrial 
      pressure (RAP) 11.5+/-4 mmHg. Hospital mortality was 10.1% (n=7/69). Mean 
      postoperative PVR on the 2nd day was 324+/-188 dynes x s x cm(-5). Pulmonary 
      angiography was reviewed for number of involved segments (mean 9.3+/-2) and 
      bronchial arteries diameter (BAD; mean 4.6+/-1.6 mm). A univariate and 
      multivariate analysis was performed to determine preoperative risk factors for 
      hospital death and inadequate hemodynamic improvement. RESULTS: By univariate 
      analysis, mortality was influenced by age (P=0.04), right atrial pressure 
      (P=0.009), NYHA (P=0.02) and the number of angiographically involved segments 
      (P=0.02). Sex, left ventricular function, presence of coronary artery disease and 
      bronchial artery diameter did not show correlation with mortality. Inadequate 
      hemodynamic improvement in a dichotomized analysis (PVR > or =500 dynes x s x 
      cm(-5), n=11, and PVR < 500 dynes x s x cm(-5), n=58), assessed by univariate 
      analysis, was significantly influenced by age (P=0.02), preoperative PVR 
      (P=0.01), NYHA (P=0.002), RAP (P=0.02) and female sex (P=0.02). Multivariate 
      analysis identified age (P=0.1), RAP (P=0.002) and female sex (P=0.007) as risk 
      factors for inferior hemodynamic improvement. CONCLUSIONS: Preoperative 
      parameters can be utilized to assess postoperative mortality and hemodynamic 
      improvement after pulmonary thromboendarterectomy. Patient age and clinical 
      deterioration of pulmonary hypertension are considerable preoperative factors 
      influencing hospital mortality. Inadequate postoperative hemodynamic improvement 
      is affected by severity of disease and female sex.
FAU - Tscholl, D
AU  - Tscholl D
AD  - Deptartment of Thoracic and Cardiovascular Surgery, University Hospital Homburg, 
      Homburg, Germany.
FAU - Langer, F
AU  - Langer F
FAU - Wendler, O
AU  - Wendler O
FAU - Wilkens, H
AU  - Wilkens H
FAU - Georg, T
AU  - Georg T
FAU - Schafers, H J
AU  - Schafers HJ
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  - Adolescent
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Blood Pressure/physiology
MH  - Child
MH  - Chronic Disease
MH  - *Endarterectomy/*mortality
MH  - Female
MH  - Hemodynamics/*physiology
MH  - Humans
MH  - Hypertension, Pulmonary/*surgery
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Artery/diagnostic imaging
MH  - Pulmonary Embolism/*surgery
MH  - Radiography
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sex Factors
MH  - Vascular Resistance/physiology
MH  - Ventricular Function, Left
EDAT- 2001/06/19 10:00
MHDA- 2001/09/21 10:01
CRDT- 2001/06/19 10:00
PHST- 2001/06/19 10:00 [pubmed]
PHST- 2001/09/21 10:01 [medline]
PHST- 2001/06/19 10:00 [entrez]
AID - S1010794001006868 [pii]
AID - 10.1016/s1010-7940(01)00686-8 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2001 Jun;19(6):771-6. doi: 
      10.1016/s1010-7940(01)00686-8.