PMID- 21163873
OWN - NLM
STAT- MEDLINE
DCOM- 20110901
LR  - 20170520
IS  - 1931-3543 (Electronic)
IS  - 0012-3692 (Linking)
VI  - 140
IP  - 1
DP  - 2011 Jul
TI  - Early postoperative pulmonary vascular compliance predicts outcome after 
      pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.
PG  - 34-41
LID - S0012-3692(11)60343-7 [pii]
LID - 10.1378/chest.10-1263 [doi]
AB  - BACKGROUND: Despite a major reduction in pulmonary vascular resistance (PVR), 
      patients with chronic thromboembolic pulmonary hypertension (CTEPH) do not always 
      return to functional New York Heart Association (NYHA) class I after pulmonary 
      endarterectomy (PEA). We hypothesized that residual abnormal compliance (Cp) 
      after PEA is associated with incomplete functional recovery despite major 
      improvement in PVR. METHODS: The Cp of 34 consecutive patients with CTEPH was 
      assessed before and after PEA. Cp was defined as stroke volume over pulse 
      pressure and was divided into three groups: < 2.0 mL/mm Hg, 2.0 to 3.9 mL/mm Hg, 
      and >/= 4 mL/mm Hg. To establish predicted Cp after PEA, we collected an age- and 
      gender-matched control group. RESULTS: Before PEA, Cp was < 2.0 mL/mm Hg in 82% 
      (n = 28) of the patients. After PEA, Cp improved to 2.0 to 3.9 mL/mm Hg in 11 
      patients and to >/= 4.0 mL/mm Hg in 14 patients. Residual Cp < 2.0 mL/mm Hg was 
      associated with delayed extubation and prolonged hospital stay. At 3 months' 
      follow-up, 13 patients (93%) with postoperative Cp >/= 4.0 mL/mm Hg returned to 
      NYHA class I, whereas 45% with Cp of 2.0 to 3.9 mL/mm Hg and 25% with Cp < 2.0 
      mL/mm Hg returned to NYHA class I. In multivariate analysis, postoperative Cp >/= 
      4.0 mL/mm Hg was the only predictor of functional recovery to NYHA class I. The 
      group of patients with postoperative Cp >/= 4.0 mL/mm Hg was also the only group to 
      achieve hemodynamic parameters similar to those of their matched control 
      subjects. CONCLUSIONS: Postoperative Cp is an important predictor of recovery 
      after PEA. Residual vascular stiffness after PEA can be associated with 
      persistent functional limitation and lack of complete remodeling of the right 
      ventricle.
FAU - de Perrot, Marc
AU  - de Perrot M
AD  - Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of 
      Toronto, Toronto, ON, Canada. Electronic address: marc.deperrot@uhn.on.ca.
FAU - McRae, Karen
AU  - McRae K
AD  - Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of 
      Toronto, Toronto, ON, Canada.
FAU - Shargall, Yaron
AU  - Shargall Y
AD  - Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of 
      Toronto, Toronto, ON, Canada.
FAU - Thenganatt, John
AU  - Thenganatt J
AD  - Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of 
      Toronto, Toronto, ON, Canada.
FAU - Moric, Jakov
AU  - Moric J
AD  - Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of 
      Toronto, Toronto, ON, Canada.
FAU - Mak, Suzanna
AU  - Mak S
AD  - Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of 
      Toronto, Toronto, ON, Canada.
FAU - Granton, John T
AU  - Granton JT
AD  - Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of 
      Toronto, Toronto, ON, Canada.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20101216
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
SB  - IM
MH  - Chronic Disease
MH  - Compliance
MH  - Endarterectomy/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Hypertension, Pulmonary/etiology/physiopathology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Postoperative Period
MH  - Prognosis
MH  - Pulmonary Artery/*physiopathology/surgery
MH  - Pulmonary Embolism/complications/physiopathology/*surgery
MH  - Recovery of Function/*physiology
MH  - Retrospective Studies
MH  - Time Factors
MH  - Vascular Resistance/*physiology
EDAT- 2010/12/18 06:00
MHDA- 2011/09/02 06:00
CRDT- 2010/12/18 06:00
PHST- 2010/12/18 06:00 [entrez]
PHST- 2010/12/18 06:00 [pubmed]
PHST- 2011/09/02 06:00 [medline]
AID - S0012-3692(11)60343-7 [pii]
AID - 10.1378/chest.10-1263 [doi]
PST - ppublish
SO  - Chest. 2011 Jul;140(1):34-41. doi: 10.1378/chest.10-1263. Epub 2010 Dec 16.