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KMID : 0364020130460010041
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Korean Journal of Thoracic and Cardiovascular Surgery
2013 Volume.46 No. 1 p.41 ~ p.48
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Clinical Outcomes of Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension: 12-Year Experience
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Oh Se-Jin
Bok Jin-San
Hwang Ho-Young
Kim Kyung-Hwan
Kim Ki-Bong
Ahn Hyuk
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Abstract
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Background: We present our 12-year experience of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. Materials and Methods: Between January 1999 and March 2011, 16 patients underwent pulmonary thromboendarterectomy. Eleven patients (69%) were classified as functional class III or IV based on the New York Heart Association (NYHA) classification. Seven patients had a history of inferior vena cava filter insertion, and 5 patients showed coagulation disorders. Pulmonary thromboendarterectomy was performed during total circulatory arrest with deep hypothermia in 14 patients. Results: In-hospital mortality and late death occurred in 2 patients (12.5%) and 1 patient (6.3%), respectively. Extracorporeal membrane oxygenation support was required in 4 patients who developed severe hypoxemia after surgery. Thirteen of the 14 survivors have been followed up for 54 months (range, 2 to 141 months). The pulmonary arterial systolic pressure and cardiothoracic ratio on chest radiography was significantly decreased after surgery (76±26 mmHg vs. 41±17 mmHg, p=0.001; 55%±8% vs. 48%±3%, p=0.003). Tricuspid regurgitation was reduced from 2.1±1.1 to 0.7±0.6 (p=0.007), and the NYHA functional class was also improved to I or II in 13 patients (81%). These symptomatic and hemodynamic improvements maintained during the late follow-up period. Conclusion: Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension shows good clinical outcomes with acceptable early and long term mortality.
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KEYWORD
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Pulmonary arteries, Thromboembolism, Endarterectomy, Tricuspid valve
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