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Thorac Cardiovasc Surg 2022; 70(08): 658-662
DOI: 10.1055/s-0041-1740560
Original Thoracic

Outcome of Surgery for Chronic Thromboembolic Pulmonary Disease without Pulmonary Hypertension

Farid Rashidi
1   Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
,
Rezayat Parvizi
2   Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
,
Eisa Bilejani
2   Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
,
Babak Mahmoudian
3   Medical Radiation Sciences Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
,
Ata Koohi 
1   Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
› Author Affiliations Funding None.
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Abstract

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious condition that results from incomplete resolution of thromboemboli in pulmonary arteries. Symptomatic patients with chronic thromboembolic disease may have normal hemodynamic at rest. The aim of this study is to evaluate the outcome of pulmonary endarterectomy (PEA) in symptomatic patients with chronic thromboembolic pulmonary disease (CTEPD) in the absence of pulmonary hypertension as currently defined (mean pulmonary artery pressure [mPAP] < 20 mm Hg).

Patients and Methods Here, we report four symptomatic patients with chronic thromboembolic and normal hemodynamic at rest (mPAP ≤20 mm Hg or 20 < mPAP < 25 mm Hg and pulmonary vascular resistance [PVR] < 240 dyn·s/cm5) who underwent PEA between September 2015 and September 2019. The main outcome measures were functional New York Heart Association class, 6-minute walk distance (6MWD), hemodynamic measures in right heart catheterization (RHC), morbidity, and mortality.

Results There were significant improvement in function class (2.6 ± 0.54 vs. 1 ± 0.2, p = 0.00), mPAP (preoperative: 23.3 ± 0.5 mm Hg vs. postoperative: 18.6 ± 1.5 mm Hg, p = 0.02), 6MWD (preoperative: 378.2 ± 68.7 m vs. postoperative: 432.9 ± 44.5 m, p = 0.01), and PVR (215.33 ± 91 vs. 101 ± 32 dyn·s/cm5, p = 0.1) 6 months after surgery based on data from RHC which was done during exercise. Also, RHC showed a significant decrease in mPAP (preoperative: 37 ± 7.7 mm Hg vs. postoperative 28 ± 3.2 mm Hg, p = 0.06).

Conclusion PEA could improve function class and hemodynamic in patients with CTEPD. Considering hemodynamic improvement in this group of patients after PEA, definition of CTEPH may need to be revised.

Keywords

pulmonary hypertension - pulmonary endarterectomy - chronic thromboembolic

Authors' Contribution

All authors reviewed and approved the final manuscript.


Data Availability Statement

Patient data are available upon request with the corresponding author.




Publication History

Received: 11 August 2021

Accepted: 28 September 2021

Article published online:
02 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Simonneau G, Montani D, Celermajer DS. et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J 2019; 53 (01) 1801913
    CrossrefPubMedSearch in Google Scholar
  • 2 Delcroix M, Torbicki A, Gopalan D. et al. ERS statement on chronic thromboembolic pulmonary hypertension. Eur Respir J 2021; 57 (06) 2002828
    Search in Google Scholar
  • 3 Kim NH. Group 4 pulmonary hypertension: chronic thromboembolic pulmonary hypertension: epidemiology, pathophysiology, and treatment. Cardiol Clin 2016; 34 (03) 435-441
    CrossrefPubMedSearch in Google Scholar
  • 4 Thistlethwaite PA, Madani M, Jamieson SW. Pulmonary thromboendarterectomy surgery. Cardiol Clin 2004; 22 (03) 467-478 , vii
    CrossrefPubMedSearch in Google Scholar
  • 5 Pengo V, Lensing AW, Prins MH. et al; Thromboembolic Pulmonary Hypertension Study Group. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350 (22) 2257-2264
    CrossrefPubMedSearch in Google Scholar
  • 6 Edward JA, Mandras S. An update on the management of chronic thromboembolic pulmonary hypertension. Curr Probl Cardiol 2017; 42 (01) 7-38
    CrossrefPubMedSearch in Google Scholar
  • 7 Madani MM. Surgical treatment of chronic thromboembolic pulmonary hypertension: pulmonary thromboendarterectomy. Methodist DeBakey Cardiovasc J 2016; 12 (04) 213-218
    CrossrefPubMedSearch in Google Scholar
  • 8 Freed DH, Thomson BM, Berman M. et al. Survival after pulmonary thromboendarterectomy: effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg 2011; 141 (02) 383-387
    CrossrefPubMedSearch in Google Scholar
  • 9 Piazza G, Goldhaber SZ. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2011; 364 (04) 351-360
    CrossrefPubMedSearch in Google Scholar
  • 10 Held M, Kolb P, Grün M. et al. Functional characterization of patients with chronic thromboembolic disease. Respiration 2016; 91 (06) 503-509
    CrossrefPubMedSearch in Google Scholar
  • 11 Galiè N, Hoeper MM, Humbert M. et al; ESC Committee for Practice Guidelines (CPG). Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2009; 30 (20) 2493-2537
    CrossrefPubMedSearch in Google Scholar
  • 12 Jenkins DP, Madani M, Mayer E. et al. Surgical treatment of chronic thromboembolic pulmonary hypertension. Eur Respir J 2013; 41 (03) 735-742
    CrossrefPubMedSearch in Google Scholar
  • 13 Moser KM, Auger WR, Fedullo PF. Chronic major-vessel thromboembolic pulmonary hypertension. Circulation 1990; 81 (06) 1735-1743
    CrossrefPubMedSearch in Google Scholar
  • 14 Taboada D, Pepke-Zaba J, Jenkins DP. et al. Outcome of pulmonary endarterectomy in symptomatic chronic thromboembolic disease. Eur Respir J 2014; 44 (06) 1635-1645
    CrossrefPubMedSearch in Google Scholar
  • 15 Olgun Yıldızeli Ş, Kepez A, Taş S. et al. Pulmonary endarterectomy for patients with chronic thromboembolic disease. Anatol J Cardiol 2018; 19 (04) 273-278
    PubMedSearch in Google Scholar
  • 16 Guth S, Wiedenroth CB, Rieth A. et al. Exercise right heart catheterisation before and after pulmonary endarterectomy in patients with chronic thromboembolic disease. Eur Respir J 2018; 52 (03) 1800458
    CrossrefPubMedSearch in Google Scholar
  • 17 Lang IM, Pesavento R, Bonderman D, Yuan JX. Risk factors and basic mechanisms of chronic thromboembolic pulmonary hypertension: a current understanding. Eur Respir J 2013; 41 (02) 462-468
    CrossrefPubMedSearch in Google Scholar
  • 18 Mercier O, Fadel E. Chronic thromboembolic pulmonary hypertension: animal models. Eur Respir J 2013; 41 (05) 1200-1206
    CrossrefPubMedSearch in Google Scholar
  • 19 Pepke-Zaba J, Delcroix M, Lang I. et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation 2011; 124 (18) 1973-1981
    CrossrefPubMedSearch in Google Scholar
  • 20 Delcroix M, Vonk Noordegraaf A, Fadel E, Lang I, Simonneau G, Naeije R. Vascular and right ventricular remodelling in chronic thromboembolic pulmonary hypertension. Eur Respir J 2013; 41 (01) 224-232
    CrossrefPubMedSearch in Google Scholar
  • 21 van der Plas MN, Reesink HJ, Roos CM, van Steenwijk RP, Kloek JJ, Bresser P. Pulmonary endarterectomy improves dyspnea by the relief of dead space ventilation. Ann Thorac Surg 2010; 89 (02) 347-352
    CrossrefPubMedSearch in Google Scholar
  • 22 Madani MM, Auger WR, Pretorius V. et al. Pulmonary endarterectomy: recent changes in a single institution's experience of more than 2,700 patients. Ann Thorac Surg 2012; 94 (01) 97-103 , discussion 103
    CrossrefPubMedSearch in Google Scholar
  • 23 Nijkeuter M, Hovens MM, Davidson BL, Huisman MV. Resolution of thromboemboli in patients with acute pulmonary embolism: a systematic review. Chest 2006; 129 (01) 192-197
    CrossrefPubMedSearch in Google Scholar
  • 24 Held M, Grün M, Holl R. et al. Cardiopulmonary exercise testing to detect chronic thromboembolic pulmonary hypertension in patients with normal echocardiography. Respiration 2014; 87 (05) 379-387
    CrossrefPubMedSearch in Google Scholar
  • 25 Held M, Hesse A, Gott F. et al. A symptom-related monitoring program after pulmonary embolism for early detection of CTEPH. BMC Pulm Med 2014; 14: 141
    CrossrefPubMedSearch in Google Scholar
  • 26 Scheidl SJ, Englisch C, Kovacs G. et al. Diagnosis of CTEPH versus IPAH using capillary to end-tidal carbon dioxide gradients. Eur Respir J 2012; 39 (01) 119-124
    CrossrefPubMedSearch in Google Scholar
  • 27 McCabe C, Deboeck G, Harvey I. et al. Inefficient exercise gas exchange identifies pulmonary hypertension in chronic thromboembolic obstruction following pulmonary embolism. Thromb Res 2013; 132 (06) 659-665
    CrossrefPubMedSearch in Google Scholar
  • 28 Zhai Z, Murphy K, Tighe H. et al. Differences in ventilatory inefficiency between pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Chest 2011; 140 (05) 1284-1291
    CrossrefPubMedSearch in Google Scholar