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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

 

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