Pulmonary endarterectomy in a Colombian cardiovascular center: experience and main outcomes
Chronic thromboembolic disease is a major cause of severe pulmonary hypertension and disabling right ventricular dysfunction. Pulmonary endarterectomy (PE) is currently considered a therapeutic option that can cure these patients.
The aim of this study was to review the experience at a Colombian PE cardiovascular center, the outcomes and most frequent complications.
Materials and methods:
A retrospective review of PEs performed from 2009 through 2017 was conducted, which form an e-database developed for cardiovascular surgery in 2009. All intra and postoperative events were recorded, as well as the major outcomes, including mortality.
Twenty-one patients (12 females and 9 males) were identified, with a mean age of 48 years [interquartile range (IQR): 30-70]; 76.2% had a New York Heart Association (NYHA) functional class category III or IV, and the mean intensive care unit stay was 179hours (IQR 27-528). The most frequent perioperative complications were cardiac (right ventricular dysfunction, and biventricular dysfunction) and pulmonary (pulmonary edema and severe dysfunction disorders), with an overall mortality of 9.5%.
Although the reported survival in this paper is similar to recently published trials, our work suggests that it is appropriate to foresee the possibility of postoperative cardiopulmonary support in these patients and to have a multidisciplinary team available, trained in caring for these events that have a negative impact on outcomes and survival of this surgical population.
2. Klok FA, van Kralingen KW, van Dijk AP, et al. Prospective cardiopulmonary screening program to detect chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism. Haematologica 2010; 95:970-975.
3. Becattini C, Agnelli G, Pesavento R, et al. Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest 2006; 130:172-175.
4. Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350:2257-2264.
5. Banks DA, Pretorius GV, Kerr KM, et al. Pulmonary endarterectomy: Part II. Operation, anesthetic management, and postoperative care. Semin Cardiothorac Vasc Anesth 2014; 18:331-340.
6. Manecke GRJr, Parimucha M, Stratmann G, et al. Deep hypothermic circulatory arrest and the femoral-to-radial arterial pressure gradient. J Cardiothorac Vasc Anesth 2004; 18:175-179.
7. Manecke GRJr. Anesthesia for pulmonary endarterectomy. Semin Thorac Cardiovasc Surg 2006; 18:236-242.
8. Demeyere R, Delcroix M, Daenen W. Anaesthesia management for pulmonary endarterectomy. Curr Opin Anaesthesiol 2005;18:63-76.
9. Kim NH, Delcroix M, Jenkins DP, et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol 2013; 62 (25 Suppl): D92-D99.
10. Mellemkjaer S, Ilkjaer LB, Klaaborg KE, et al. Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ten years experience in Denmark. Scand Cardiovasc J 2006; 40:49-53.
11. Jamieson SW, Kapelanski DP, Sakakibara N, et al. Pulmonary endarterectomy: experience and lessons learned in 1,500 cases. Ann Thorac Surg 2003; 76:1457-1462. discussion 62-64.
12. 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; 94:97-103. discussion.
13. Favaloro RR, Peradejordi MA, Gomez CB, et al. Tromboendarter-ectomia pulmonar: tratamiento de elección para la hipertensión pulmonar tromboembólica crónica. Revista Americana de Medicina Respiratoria 2011; 11:74-83.
14. Kim NH, Madani MM, Pretorius V, et al. Pulmonary Thromboen-darterectomy Outcome in Patients with High Pre-operative PVR: UCSD Single Center Experience (Internet). American Thoracic Society International Conference Abstracts). [Cited 02 Nov 17]. Disponible desde: http://www.atsjournals.org/doi/pdf/10.1164/ajrccm-conference.2013.187.1_MeetingAbstracts.A3342
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