PMID- 35433364
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2225-319X (Print)
IS  - 2304-1021 (Electronic)
IS  - 2225-319X (Linking)
VI  - 11
IP  - 2
DP  - 2022 Mar
TI  - Pulmonary endarterectomy in severe chronic thromboembolic pulmonary hypertension: 
      the Toronto experience.
PG  - 133-142
LID - 10.21037/acs-2021-pte-14 [doi]
AB  - BACKGROUND: Pulmonary endarterectomy (PEA) in severe chronic thromboembolic 
      pulmonary hypertension (CTEPH) is associated with higher risks. However, recent 
      evidence suggests that these risks may be mitigated with the use of 
      extracorporeal membrane oxygenation (ECMO). METHODS: We performed a retrospective 
      analysis of 401 consecutive patients undergoing PEA at the Toronto General 
      Hospital between August 2005 and March 2020. Patients with severe CTEPH defined 
      by pulmonary vascular resistance (PVR) >1,000 dynes.s.cm(-5) at the time of 
      diagnosis were compared to those with PVR <1,000 dynes.s.cm(-5). RESULTS: The New 
      York Heart Association (NYHA) functional class, brain natriuretic peptide (BNP) 
      and 6-minute walk distance were worse in patients with PVR >1,000 dynes.s.cm(-5). 
      A greater proportion of patients with PVR >1,000 dynes.s.cm(-5) was treated with 
      targeted pulmonary hypertension (PH) medical therapy (38% vs. 18%, P<0.001) and 
      initiated on inotropic support (7% vs. 0.3%, P<0.001) before PEA. Since 2014, the 
      ECMO utilization rate increased in patients with PVR >1,000 dynes.s.cm(-5) 
      compared to those with PVR <1,000 dynes.s.cm(-5) (18% vs. 3.1%, P<0.001). The 
      hospital mortality in patients with PVR >1,000 dynes.s.cm(-5) decreased from 
      10.3% in 2005-2013 to 1.6% in 2014-2020 (P=0.05), while the hospital mortality in 
      patients with PVR <1,000 dynes.s.cm(-5) remained stable (1.2% in 2005-2013 vs. 
      2.7% in 2014-2020, P=0.4). The overall survival reached 84% at 10 years in 
      patients with PVR >1,000 dynes.s.cm(-5) compared to 78% in patients with PVR 
      <1,000 dynes.s.cm(-5) (P=0.7). CONCLUSIONS: The early and long-term results of 
      PEA in patients with severe CTEPH are excellent despite greater postoperative 
      risks. ECMO as a bridge to recovery after PEA can be useful in patients with 
      severe CTEPH.
CI  - 2022 Annals of Cardiothoracic Surgery. All rights reserved.
FAU - de Perrot, Marc
AU  - de Perrot M
AD  - Toronto CTEPH Program, Toronto General Hospital, University Health Network, 
      University of Toronto, Toronto, Canada.
FAU - McRae, Karen
AU  - McRae K
AD  - Toronto CTEPH Program, Toronto General Hospital, University Health Network, 
      University of Toronto, Toronto, Canada.
FAU - Donahoe, Laura
AU  - Donahoe L
AD  - Toronto CTEPH Program, Toronto General Hospital, University Health Network, 
      University of Toronto, Toronto, Canada.
FAU - Abdelnour-Berchtold, Etienne
AU  - Abdelnour-Berchtold E
AD  - Toronto CTEPH Program, Toronto General Hospital, University Health Network, 
      University of Toronto, Toronto, Canada.
FAU - Thenganatt, John
AU  - Thenganatt J
AD  - Toronto CTEPH Program, Toronto General Hospital, University Health Network, 
      University of Toronto, Toronto, Canada.
FAU - Granton, John
AU  - Granton J
AD  - Toronto CTEPH Program, Toronto General Hospital, University Health Network, 
      University of Toronto, Toronto, Canada.
CN  - Canadian CTEPH Working Group
LA  - eng
PT  - Journal Article
PL  - China
TA  - Ann Cardiothorac Surg
JT  - Annals of cardiothoracic surgery
JID - 101605877
PMC - PMC9012204
OTO - NOTNLM
OT  - Pulmonary thromboendarterectomy (PTE)
OT  - pulmonary emboli
OT  - pulmonary hypertension (PH)
OT  - surgery
COIS- Conflicts of Interest: The authors have no conflicts of interest to declare.
EDAT- 2022/04/19 06:00
MHDA- 2022/04/19 06:01
PMCR- 2022/03/01
CRDT- 2022/04/18 06:38
PHST- 2021/09/07 00:00 [received]
PHST- 2021/12/14 00:00 [accepted]
PHST- 2022/04/18 06:38 [entrez]
PHST- 2022/04/19 06:00 [pubmed]
PHST- 2022/04/19 06:01 [medline]
PHST- 2022/03/01 00:00 [pmc-release]
AID - acs-11-02-133 [pii]
AID - 10.21037/acs-2021-pte-14 [doi]
PST - ppublish
SO  - Ann Cardiothorac Surg. 2022 Mar;11(2):133-142. doi: 10.21037/acs-2021-pte-14.