Thorac Cardiovasc Surg 2023; 71(05): 407-412
DOI: 10.1055/s-0042-1760204
Original Cardiovascular

Single-Center Experience of Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension: The Results from the Tabriz University Medical Sciences (TUMS) CTEPH Program

Rezayat Parvizi
1   Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
,
Eisa Bilehjani
1   Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
,
Babak Mahmoudian
2   Medical Radiation Sciences Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
,
3   Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
,
Hooriah Shojaan
3   Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
,
Khalil Ansarin
3   Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
,
Farid Rashidi
3   Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
› Author Affiliations
Funding The authoring team received no funding for this report.

Abstract

Introduction Pulmonary endarterectomy (PEA) remains the preferred and potentially curative option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to report the results of PEA for CTEPH in a tertiary center in Tabriz, Iran.

Methods We analyzed the results of 42 CTEPH patients undergoing PEA, who were enrolled in the Tabriz University of Medical Sciences (TUMS-CTEPH) from January 2016 to October 2020. The main outcome measures included the New York Heart Association (NYHA) functional classification, the 6-Minute Walk Distance, hemodynamic measures in right heart catheterization, morbidity, and mortality.

Results There was a significant improvement in the NYHA function class (2.6 ± 0.5 vs 1.1 ± 0.34), mean pulmonary arterial pressure (47.1 ± 13 vs 27.9 ± 8 mm Hg), cardiac output (4.3 ± 1.06 vs 5.9 ± 1.2 L/min), and pulmonary vascular resistance (709.4 ± 297.5 vs 214 ± 77 dyn s/cm5). Fifteen patients (35%) developed complications. The most common complication (10 [23%]) was reperfusion injury. Also, postsurgical mortality was 4% during hospital admission and 1-year follow-up.

Conclusion This is the first single-center report of PEA from Iran. Post-PEA and 1-year survival were acceptable as a referral center. PEA can be performed safe with low mortality. Greater awareness of PEA and patients' access to experienced CTEPH centers are important issues.

Disclosure

The material is available as a preprint on Research Square.


Authors' Contribution

F.R. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: F.R., R.P., E.B., A.K., B.M., and K.A. The first draft of the manuscript was written by F.R. and R.P., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.




Publication History

Received: 28 August 2022

Accepted: 22 November 2022

Article published online:
19 January 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 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
  • 2 Moser KM, Bloor CM. Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest 1993; 103 (03) 685-692
  • 3 Riedel M, Stanek V, Widimsky J, Prerovsky I. Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. Chest 1982; 81 (02) 151-158
  • 4 Mayer E, Jenkins D, Lindner J. et al. Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. J Thorac Cardiovasc Surg 2011; 141 (03) 702-710
  • 5 Daily PO, Johnston GG, Simmons CJ, Moser KM. Surgical management of chronic pulmonary embolism: surgical treatment and late results. J Thorac Cardiovasc Surg 1980; 79 (04) 523-531
  • 6 Moser KM, Auger WR, Fedullo PF, Jamieson SW. Chronic thromboembolic pulmonary hypertension: clinical picture and surgical treatment. Eur Respir J 1992; 5 (03) 334-342
  • 7 Thistlethwaite PA, Mo M, Madani MM. et al. Operative classification of thromboembolic disease determines outcome after pulmonary endarterectomy. J Thorac Cardiovasc Surg 2002; 124 (06) 1203-1211
  • 8 Menzel T, Kramm T, Wagner S, Mohr-Kahaly S, Mayer E, Meyer J. Improvement of tricuspid regurgitation after pulmonary thromboendarterectomy. Ann Thorac Surg 2002; 73 (03) 756-761
  • 9 Maliyasena VA, Hopkins PM, Thomson BM. et al. An Australian tertiary referral center experience of the management of chronic thromboembolic pulmonary hypertension. Pulm Circ 2012; 2 (03) 359-364
  • 10 Ogino H, Ando M, Matsuda H. et al. Japanese single-center experience of surgery for chronic thromboembolic pulmonary hypertension. Ann Thorac Surg 2006; 82 (02) 630-636
  • 11 Kramm T, Eberle B, Krummenauer F, Guth S, Oelert H, Mayer E. Inhaled iloprost in patients with chronic thromboembolic pulmonary hypertension: effects before and after pulmonary thromboendarterectomy. Ann Thorac Surg 2003; 76 (03) 711-718
  • 12 Ji B, Li C, Wang G. et al. The management of cardiopulmonary bypass during pulmonary artery embolectomy in hyperthermia. Chin J Clin Thorac Cardiovasc Surg 2001; 8: 128-129
  • 13 Liu J, Sun G, Ji B. et al. Management of cardiopulmonary bypass in the operation for DeBakey type III aortic dissection. Chin J Clin Thorac Cardiovasc Surg 2005; 12: 434-435
  • 14 Allison PR, Dunnill MS, Marshall R. Pulmonary embolism. Thorax 1960; 15 (04) 273-283
  • 15 Jamieson SW, Kapelanski DP, Sakakibara N. et al. Pulmonary endarterectomy: experience and lessons learned in 1,500 cases. Ann Thorac Surg 2003; 76 (05) 1457-1462 , discussion 1462–1464
  • 16 Fedullo PF, Auger WR, Kerr KM, Rubin LJ. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2001; 345 (20) 1465-1472
  • 17 Mayer E. Surgical and post-operative treatment of chronic thromboembolic pulmonary hypertension. Eur Respir Rev 2010; 19 (115) 64-67
  • 18 Hartz RS, Byrne JG, Levitsky S, Park J, Rich S. Predictors of mortality in pulmonary thromboendarterectomy. Ann Thorac Surg 1996; 62 (05) 1255-1259 , discussion 1259–1260
  • 19 Jaïs X, D'Armini AM, Jansa P. et al; Bosentan Effects in iNopErable Forms of chronIc Thromboembolic pulmonary hypertension Study Group. Bosentan for treatment of inoperable chronic thromboembolic pulmonary hypertension: BENEFiT (Bosentan Effects in iNopErable Forms of chronIc Thromboembolic pulmonary hypertension), a randomized, placebo-controlled trial. J Am Coll Cardiol 2008; 52 (25) 2127-2134
  • 20 Suntharalingam J, Treacy CM, Doughty NJ. et al. Long-term use of sildenafil in inoperable chronic thromboembolic pulmonary hypertension. Chest 2008; 134 (02) 229-236
  • 21 Ghofrani HA, D'Armini AM, Grimminger F. et al; CHEST-1 Study Group. Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med 2013; 369 (04) 319-329
  • 22 Reesink HJ, Surie S, Kloek JJ. et al. Bosentan as a bridge to pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. J Thorac Cardiovasc Surg 2010; 139 (01) 85-91
  • 23 Pepke-Zaba J, Ghofrani HA, Hoeper MM. Medical management of chronic thromboembolic pulmonary hypertension. Eur Respir Rev 2017; 26 (143) 160107
  • 24 Gopalan D, Delcroix M, Held M. Diagnosis of chronic thromboembolic pulmonary hypertension. Eur Respir Rev 2017; 26 (143) 160108
  • 25 Tscholl D, Langer F, Wendler O, Wilkens H, Georg T, Schäfers HJ. Pulmonary thromboendarterectomy–risk factors for early survival and hemodynamic improvement. Eur J Cardiothorac Surg 2001; 19 (06) 771-776
  • 26 Newnham M, Hernández-Sánchez J, Dunning J. et al. Age should not be a barrier for pulmonary endarterectomy in carefully selected patients. Eur Respir J 2017; 50 (06) 1701804
  • 27 Levinson RM, Shure D, Moser KM. Reperfusion pulmonary edema after pulmonary artery thromboendarterectomy. Am Rev Respir Dis 1986; 134 (06) 1241-1245
  • 28 Kerr KM, Auger WR, Marsh JJ. et al. Efficacy of methylprednisolone in preventing lung injury following pulmonary thromboendarterectomy. Chest 2012; 141 (01) 27-35
  • 29 Jenkins DP, Madani M, Mayer E. et al. Surgical treatment of chronic thromboembolic pulmonary hypertension. Eur Respir J 2013; 41 (03) 735-742
  • 30 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
  • 31 Sugiyama K, Suzuki S, Fujiyoshi T, Koizumi N, Sato M, Ogino H. Extracorporeal membrane oxygenation after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. J Card Surg 2019; 34 (06) 428-434
  • 32 Kim NH, Delcroix M, Jenkins DP. et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol 2013; 62 (25, Suppl): D92-D99
  • 33 Condliffe R, Kiely DG, Gibbs JS. et al. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med 2008; 177 (10) 1122-1127
  • 34 Rahnavardi M, Yan TD, Cao C, Vallely MP, Bannon PG, Wilson MK. Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension : a systematic review. Ann Thorac Cardiovasc Surg 2011; 17 (05) 435-445