PMID- 17312900
OWN - NLM
STAT- MEDLINE
DCOM- 20070313
LR  - 20181113
IS  - 0022-1058 (Print)
IS  - 0022-1058 (Linking)
VI  - 38
IP  - 4
DP  - 2006 Dec
TI  - Perfusion techniques for pulmonary thromboendarterectomy under deep hypothermia 
      circulatory arrest: a case series.
PG  - 302-6
AB  - Pulmonary thromboendarterectomy (PTE) is a complicated surgical procedure that is 
      an effective treatment in reducing pulmonary artery pressure and pulmonary 
      vascular resistance for chronic thromboembolic pulmonary hypertension. Chronic 
      thromboembolic pulmonary hypertension usually results from incomplete lysis of a 
      large organized thrombus in the main pulmonary artery and secondary branches, 
      leading to pulmonary hypertension, right ventricular failure, and subsequent 
      death because of heart failure. Between March 1997 and April 2005, 30 PTE 
      operations were performed in Fuwai Hospital, Beijing, China. They were 24 men and 
      6 women, with an average age of 45.7 +/- 11.4 years and average disease history 
      of 48 +/- 12.6 months. Twelve of them were in New York Heart Association (NYHA) 
      class 4, and 18 were in class 3. Seventeen cases were found with deep venous 
      thrombosis (DVT), and inferior vena cava filters were implanted before surgery. 
      The mean systolic pulmonary pressure was 91.4 +/- 22.4 mmHg, mean pressure of 
      arterial oxygen (PaO2) was 56.2 +/- 8.6 mmHg, mean cardiac index (CI) was 1.64 
      +/- 0.47 L/min/m2, and mean saturation of arterial oxygen (SaO2) was 0.90 +/- 
      0.05. All operations were performed using the PTE procedure under deep 
      hypothermia and intermittent circulation arrest. Perfusion management consisted 
      of myocardial, cerebral protection, lung protection, and deep hypothermia with 
      multiple periods of circulatory arrest and reperfusion at hypothermia, 
      ultrafiltration, and cell-saving techniques. One patient died of infective shock 
      post-operatively. Four cases experienced complications of the central nervous 
      system. The mean cardiopulmonary bypass time was 191.1 +/- 34.4 minutes, the mean 
      aortic clamping time was 95.1 +/- 27.8 minutes, and mean circulation arrest time 
      was 47.7 +/- 12.9 minutes. Improvement of hemodynamic status occurred immediately 
      after surgery. Mean pulmonary artery pressure decreased from 91.4 +/- 22.4 to 
      48.3 +/- 10.7 mmHg, and CI increased from 1.64 +/- 0.47 to 2.58 +/- 0.51 L/min/ 
      m2. PaO2 increased from 56.2 +/- 8.6 to 88.9 +/- 6.0 mmHg and SaO2 increased from 
      0.90 +/- 0.05 to 0.97 +/- 0.01. Twenty-six cases were followed for 36.8 months: 
      22 in NYHA class 1, 3 in class 2, and 1 in class 3. PTE is an effective treatment 
      for chronic thromboembolic pulmonary hypertension. The key to success is to adopt 
      synthesized measures to protect the vital organ under deep hypothermic 
      circulatory arrest (DHCA) from ischemia and reperfusion injury. Appropriate 
      patient selection, perioperative management, improved techniques, and experience 
      can optimize outcome.
FAU - Ji, Bingyang
AU  - Ji B
AD  - Department of Cardiopulmonary Bypass, Cardiovascular Institute and Fuwai 
      Hospital, PUMC and CAMS, Beijing, China. bingyangji@psu.edu
FAU - Liu, Jinping
AU  - Liu J
FAU - Wu, Yongbo
AU  - Wu Y
FAU - Wang, Guyan
AU  - Wang G
FAU - Feng, Zhengyi
AU  - Feng Z
FAU - Liu, Mingzheng
AU  - Liu M
FAU - Long, Cun
AU  - Long C
FAU - Song, Yunhu
AU  - Song Y
LA  - eng
PT  - Journal Article
PL  - France
TA  - J Extra Corpor Technol
JT  - The journal of extra-corporeal technology
JID - 0267637
MH  - Adult
MH  - Cardiopulmonary Bypass/adverse effects/*methods
MH  - *Circulatory Arrest, Deep Hypothermia Induced
MH  - *Endarterectomy
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/etiology/surgery
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Embolism/complications/*surgery
MH  - Reperfusion Injury
MH  - Retrospective Studies
PMC - PMC4680740
COIS- The senior author has stated that authors have reported no material, financial or 
      other relationship with any healthcare-related business or other entity whose 
      products or services are discussed in this paper.
EDAT- 2007/02/23 09:00
MHDA- 2007/03/14 09:00
PMCR- 2007/06/01
CRDT- 2007/02/23 09:00
PHST- 2007/02/23 09:00 [pubmed]
PHST- 2007/03/14 09:00 [medline]
PHST- 2007/02/23 09:00 [entrez]
PHST- 2007/06/01 00:00 [pmc-release]
AID - ject.2006.38.4.302 [pii]
PST - ppublish
SO  - J Extra Corpor Technol. 2006 Dec;38(4):302-6.