Pneumologie 2020; 74(S 01): 62
DOI: 10.1055/s-0039-3403191
Posterbegehung (PO10) – Sektion Klinische Pneumologie
Therapiefortschritte bei Kollagenose-assoziierten ILDs & pulmonaler Hypertonie
Georg Thieme Verlag KG Stuttgart · New York

Supervised exercise training in patients with chronic thromboembolic pulmonary hypertension (CTEPH) as early follow-up treatment after pulmonary endarterectomy (PEA) – a prospective cohort study

C Nagel
1   Zentrum für Pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg; Klinik für Pneumologie und Thoraxchirurgie, Klinikum Mittelbaden, Baden-Baden Bühl
,
M Nasereddin
2   Center for Pulmonary Hypertension Thoraxklinik, Heidelberg University Hospital; Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl), Heidelberg, Germany
,
N Benjamin
2   Center for Pulmonary Hypertension Thoraxklinik, Heidelberg University Hospital; Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl), Heidelberg, Germany
,
B Egenlauf
2   Center for Pulmonary Hypertension Thoraxklinik, Heidelberg University Hospital; Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl), Heidelberg, Germany
,
S Harutyunova
2   Center for Pulmonary Hypertension Thoraxklinik, Heidelberg University Hospital; Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl), Heidelberg, Germany
,
C Eichstaedt
2   Center for Pulmonary Hypertension Thoraxklinik, Heidelberg University Hospital; Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl), Heidelberg, Germany
,
P Xanthouli
2   Center for Pulmonary Hypertension Thoraxklinik, Heidelberg University Hospital; Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl), Heidelberg, Germany
,
E Mayer
3   Department of Thoracic Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
,
E Grünig
2   Center for Pulmonary Hypertension Thoraxklinik, Heidelberg University Hospital; Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl), Heidelberg, Germany
,
S Guth
3   Department of Thoracic Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
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Publikationsverlauf

Publikationsdatum:
28. Februar 2020 (online)

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    Background: Safety, feasibility and effect of combined supervised inpatient rehabilitation as early follow-up treatment after pulmonary endarterectomy (PEA) has not yet been prospectively investigated in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

    Methods: Forty-five patients with CTEPH (49% female, 57.6 ± 12.4 years, 60% WHO functional class III pre-PEA) started a 19 weeks rehabilitation program (3-weeks inpatient and continued at home for another 16 weeks) with supervised exercise training as follow-up treatment shortly after PEA. Haemodynamics were assessed by right heart catheterization before PEA and 22 weeks post PEA. Non-invasive assessments as transthoracic echocardiography and 6-minute walking test (6MWD) were performed before PEA and after 3 (= beginning of rehabilitation), 6- and 22-weeks post PEA.

    Results: Rehabilitation was started 3.3 ± 0.9 weeks after PEA. Exercise training was well tolerated in all patients without severe side effects. Haemodynamics measured by right heart catheterization significantly improved from pre PEA to 22 weeks post PEA in cardiac output (+ 1.2 ± 1.5 l/min, equals 33.4%, p = 0.001) and mean pulmonary arterial pressure (− 19 ± 13 mmHg, equals − 39.6%, p < 0.0001). Right heart size measured by echocardiography, 6MWD, quality of life and oxygen saturation significantly improved not only within the first 3 weeks after PEA but also during the following 19 weeks during exercise training.

    Conclusions: Supervised exercise training was feasible and safe as early follow-up treatment after PEA. It seemed to help patients to recover more quickly from operation and further improved exercise capacity and right heart size. Further controlled studies are needed to discriminate the effects of PEA and early follow-up rehabilitation.

    Trial Registration: The study was registered at clinicaltrials.gov (NCT01393327) on July 13, 2011. Study start date was January 2010, completion date December 2015.


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