American journal of respiratory and critical care medicine · 2008
Long-term outcome after pulmonary endarterectomy.
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Corsico Angelo G, D'Armini Andrea M, Cerveri Isa, Klersy Catherine, Ansaldo Elena, Niniano Rosanna, Gatto Elena, Monterosso Cristian, Morsolini Marco, Nicolardi Salvatore, Tramontin Corrado, Pozzi Ernesto, Viganò Mario
Аннотация
RATIONALE: There are few follow-up studies on long-term cardiopulmonary function after pulmonary endarterectomy (PEA), the operation of choice for chronic thromboembolic pulmonary hypertension (CTEPH).
OBJECTIVES: To prospectively evaluate long-term outcome of patients with CTEPH treated with PEA.
METHODS: Between 1994 and 2006, 157 patients (mean age 55 yr) were treated with PEA at Pavia University Hospital. The patients were evaluated before PEA and at 3 months (n = 132), 1 year (n = 110), 2 years (n = 86), 3 years (n = 69), and 4 years (n = 49) afterward by NYHA class, right heart hemodynamic, spirometry, carbon monoxide transfer factor (Tl(CO)), arterial blood gas, and treadmill incremental exercise test.
MEASUREMENTS AND MAIN RESULTS: Cumulative survival was 84%. Within 3 months, 18 patients died in-hospital and 2 had lung transplantation; during long-term follow-up, 6 died, 1 had lung transplantation, and 3 had a second PEA (2.5 events per 100 person-years). NYHA class III-IV was the most important predictor of late death, lung transplant, or PEA redo (hazard ratio, 3.94). Extraordinary improvement in NYHA class, hemodynamic, and Pa(O(2)) were achieved in the first 3 months (P < 0.001) and persisted during follow-up; exercise tolerance progressively increased over time (P < 0.001). At 4 years, although 74% of the patients were in NYHA class I and none was in class IV, 24% had pulmonary vascular resistance greater than 500 dyne.s/cm(5) or Pa(O(2)) less than 60 mm Hg; they were significantly older and were more frequently in NYHA class III-IV 3 months after surgery than the others.
CONCLUSIONS: After PEA, long-term survival and cardiopulmonary function recovery is excellent in most patients.
OBJECTIVES: To prospectively evaluate long-term outcome of patients with CTEPH treated with PEA.
METHODS: Between 1994 and 2006, 157 patients (mean age 55 yr) were treated with PEA at Pavia University Hospital. The patients were evaluated before PEA and at 3 months (n = 132), 1 year (n = 110), 2 years (n = 86), 3 years (n = 69), and 4 years (n = 49) afterward by NYHA class, right heart hemodynamic, spirometry, carbon monoxide transfer factor (Tl(CO)), arterial blood gas, and treadmill incremental exercise test.
MEASUREMENTS AND MAIN RESULTS: Cumulative survival was 84%. Within 3 months, 18 patients died in-hospital and 2 had lung transplantation; during long-term follow-up, 6 died, 1 had lung transplantation, and 3 had a second PEA (2.5 events per 100 person-years). NYHA class III-IV was the most important predictor of late death, lung transplant, or PEA redo (hazard ratio, 3.94). Extraordinary improvement in NYHA class, hemodynamic, and Pa(O(2)) were achieved in the first 3 months (P < 0.001) and persisted during follow-up; exercise tolerance progressively increased over time (P < 0.001). At 4 years, although 74% of the patients were in NYHA class I and none was in class IV, 24% had pulmonary vascular resistance greater than 500 dyne.s/cm(5) or Pa(O(2)) less than 60 mm Hg; they were significantly older and were more frequently in NYHA class III-IV 3 months after surgery than the others.
CONCLUSIONS: After PEA, long-term survival and cardiopulmonary function recovery is excellent in most patients.
Предметные рубрики MeSH
AdolescentAdultAgedAged, 80 and overChildChronic DiseaseEndarterectomyExercise TestFemaleFibromuscular DysplasiaFollow-Up StudiesHemodynamicsHospital MortalityHumansHypertension, PulmonaryMaleMiddle AgedOxygenPostoperative ComplicationsProspective StudiesPulmonary ArteryPulmonary Diffusing CapacityPulmonary EmbolismPulmonary Gas ExchangeRespiratory InsufficiencySpirometrySurvival RateVascular ResistanceVentricular Function, Right