Long-term Anamnesis of Chronic Thromboembolic Pulmonary Disease. Does it Predict the results of Pulmonary Thromboendarterectomy?
Keywords:
Quality improvement, brazil, organ transplantation, management program, PAT-MA, health systems, Maranh, pulmonary hypertension., Chronic thromboembolic pulmonary hypertension, Thrombendarterectomy, Pulmonary vascular resistance, Long-term medical history.Abstract
Abstract.
Introduction: Pulmonary thromboendarterectomy (PEA) is the main method of treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). The residual pulmonary hypertension (PH) after CTEPH surgical treatment is a risk factor with increasing of hospital mortality.
Objective: To analyze and evaluate the results of PEA in patients with different persistent time of medical history as a possible prognostic factor of residual PH and outcome.
Methods: Retrospective and prospective analysis of the PEA results in 87 patients operated on from April 2012 to February 2022 was conducted. The patients were divided into 3 groups. The 1st group – 45 patients with a medical history from 3 months to 1 year, the 2nd – 20 patients from 1 year to 3 years and the 3rd -22 patients with long-term history more than3 years.
Results: The average age of the patients was 48.7 ±13.5 years, including56.7% males and43.3% females. Due to New York Heart Association (NYHA),7(8.0%) patients preoperatively belonged to class II,60(69.0%) to class III and20(23.0%) to class IV. Postoperatively the mean pulmonary artery pressure (mPAP mmHg) and pulmonary vascular resistance (PVR dyn·s·cm⁻⁵) significantly decreased in all groups (mPAP:1st group from45±13 to23±6,2nd – from49±14 to25±6 and3rd – from58±12 to31±7; PVR:1st group from797±262 to290±135,2nd – from925±383 to376±159 and3rd – from1248±332 to505±189). Hospital mortality after PEA was0 in patients with medical history less than1 year,5% from1 to3 years and31% in patients with long-term anamnesis.
Conclusions. PEA is an effective surgery with mPAP and PVR decreasing in the early postoperative period. However, long-term medical history and PVR >1000 dyn·s·cm⁻⁵ are very important risk factors with increasing of hospital mortality.
References
Delcroix, Lang, Pepke-Zaba (2016) Long-term outcome of patients with chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. 133, 859–71. https://doi.org/10.1161/CIRCULATIONAHA.115.016522
Chazova, Martynyuk (2016) Clinical recommendations for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension. 10, 63-72. https://doi.org/10.17116/terarkh201688663-73
Durrington, Hurdman, Elliott, Maclean, Van Veen, Saccullo (2024) Systematic pulmonary embolism follow-up increases diagnostic rates of chronic thromboembolic pulmonary hypertension and identifies less severe disease: results from the ASPIRE Registry. 63, 2300846. https://doi.org/10.1183/13993003.00846-2023
Kovacs, Berghold, Scheidl, Olschewski (2009) Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review. 34, 888–894. https://doi.org/10.1183/09031936.00145608
Humbert, Kovacs, Hoeper, Badagliacca, Berger, Brida (2022) 2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension. 43, 3618-3731. https://doi.org/10.1093/eurheartj/ehac237
Jenkins, Madani, Fadel, D'Armini, Mayer (2017) Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension. 26, 160111. https://doi.org/10.1183/16000617.0111-2016
Madani, Auger, Pretorius, Sakakibara, Kerr, Kim (2012) Pulmonary endarterectomy: recent changes in a single institution's experience of more than 2,700 patients. 94(1), 97-103. https://doi.org/10.1016/j.athoracsur.2012.04.004
de Perrot, McRae, Donahoe, Abdelnour-Berchtold, Thenganatt, Granton (2022) Pulmonary endarterectomy in severe chronic thromboembolic pulmonary hypertension: the Toronto experience. 11, 133–142. https://doi.org/10.21037/acs-2021-pte-14
Gorbachevsky, Rakhmonov, Aybazov, Petrosyan, Bockeria (2024) Results of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. 25(1), 56-69. https://doi.org/10.24022/1810-0694-2024-25-1-56-69
Gorbachevsky, Bockeria, Averina, Rakhmonov, Sabitov, Diasamidze, Golukhova (2025) 70 Cases of Pulmonary Thromboendarterectomy without Circulatory Arrest. 15(2). https://doi.org/10.4236/wjcs.2025.152005
Kallonen, Korsholm, Bredin, Corbascio, Jønsson Andersen, Ilkjær (2022) Association of Residual Pulmonary Hypertension with Survival after Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension. 12, e12093. https://doi.org/10.1002/pul2.12093
Simonneau, Dorfmüller, Guignabert, Mercier, Humbert (2022) Chronic thromboembolic pulmonary hypertension: the magic of pathophysiology. 11(2), 106-119. https://doi.org/10.21037/acs-2021-pte-10
Dorfmüller, Günther, Ghigna, Thomas de Montpréville, Boulate, Paul (2014) Microvascular disease in chronic thromboembolic pulmonary hypertension: a role for pulmonary veins and systemic vasculature. 44(5), 1275-88. https://doi.org/10.1183/09031936.00169113
Simonneau, Hoeper (2017) Evaluation of the incidence of rare diseases: difficulties and uncertainties, the example of chronic thromboembolic pulmonary hypertension. 49(2), 1602522. https://doi.org/10.1183/13993003.02522-2016
Azarian, Wartski, Collignon, Parent, Hervé, Sors, Simonneau (1997) Lung perfusion scans and hemodynamics in acute and chronic pulmonary embolism. 38, 980–983.
Pepke-Zaba, Delcroix, Lang, Mayer, Jansa, Ambroz (2011) Chronic Thromboembolic Pulmonary Hypertension (CTEPH): Results from an International Prospective Registry. 124, 1973-1981. https://doi.org/10.1161/circulationaha.110.015008
Thistlethwaite, Madani, Deutsch, Blanchard, Kapelanski, Jamieson (2002) Operative classification of thromboembolic disease determines outcome after pulmonary endarterectomy. 124(6), 1203-11. https://doi.org/10.1067/mtc.2002.127313
Mayer, Jenkins, Lindner, D'Armini, Kloek, Meyns (2011) Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: Results from an international prospective registry. 141, 702–710. https://doi.org/10.1016/j.jtcvs.2010.11.024
Bergin, Sirlin, Deutsch, Fedullo, Hauschildt, Huynh (2000) Predictors of patient response to pulmonary thromboendarterectomy. 174, 509–15. https://doi.org/10.2214/ajr.174.2.1740509
Sihag, Le, Witkin, Rodriguez-Lopez, Villavicencio, Vlahakes (2017) Quantifying the Learning Curve for Pulmonary Thromboendarterectomy. 12, 121. https://doi.org/10.1186/s13019-017-0686-1
Miyahara, Schröder, Wilkens, Karliova, Langer, Kunihara (2021) Long-Term Outcomes after Pulmonary Endarterectomy in 499 Patients over a 20-Year Period. 111, 1585-1592. https://doi.org/10.1016/j.athoracsur.2020.06.122
Jamieson, Kapelanski, Sakakibara, Manecke, Thistlethwaite, Kerr (2003) Pulmonary Endarterectomy: Experience and Lessons Learned in 1,500 Cases. 76, 1457-1464. https://doi.org/10.1016/s0003-4975(03)00828-2
Cannon, Su, Kiely, Page, Toshner, Swietlik (2016) Dynamic Risk Stratification of Patient Long-Term Outcome after Pulmonary Endarterectomy: Results from the United Kingdom National Cohort. 133, 1761-1771. https://doi.org/10.1161/circulationaha.115.019470
Vuylsteke, Sharples, Charman, Kneeshaw, Tsui, Dunning (2011) Circulatory arrest versus cerebral perfusion during pulmonary endarterectomy surgery (PEACOG): a randomized controlled trial. 378, 1379-1387. https://doi.org/10.1016/S0140-6736(11)61144-6
Hsieh, Jansa, Huang, Niznansky, Omara, Lindner (2018) Residual pulmonary hypertension after pulmonary endarterectomy: A meta-analysis. https://doi.org/10.1016/j.jtcvs.2018.04.110
Chernyavsky, Edemsky, Chernyavsky, Efimenko, Tarkova, Ivanov (2016) The effectiveness of thrombendarterectomy from branches of the pulmonary artery depending on the degree of pulmonary hypertension and duration of the disease. 56(5), 56-59. https://doi.org/10.18565/cardio.2016.6.56-59
Banks (2014) Pulmonary endarterectomy: part I. Pathophysiology, clinical manifestations, and diagnostic evaluation of chronic thromboembolic pulmonary hypertension. 319–330. https://doi.org/10.1177/1089253214536621
Delcroix, Vonk Noordegraaf, Fadel, Lang, Simonneau, Naeije (2013) Vascular and right ventricular remodelling in chronic thromboembolic pulmonary hypertension. 41, 224–232. https://doi.org/10.1183/09031936.00047712
Lang, Dorfmüller, Vonk Noordegraaf (2016) The Pathobiology of Chronic Thromboembolic Pulmonary Hypertension. 13(Suppl. 3), S215–221. https://doi.org/10.1513/AnnalsATS.201509-620AS
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Authors and Global Journals Private Limited
This work is licensed under a Creative Commons Attribution 4.0 International License.
