Chronic thromboembolic pulmonary hypertension: Outcomes of surgical effect in patients with unilateral main pulmonary artery occlusion_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONG Wu , ZHONG Zhaoji , ZHENG Shanshan , SONG Yunhu ,  LIU Sheng

Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;

Corresponding author：

LIU Sheng, Email: liusheng@fuwai.com

Keywords：

Pulmonary hypertension; thromboembolism; unilateral occlusion; endarterectomy; surgical treatment

DOI：

10.7507/1007-4848.201911040

Video：

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Objective To summarize the clinical characteristics and the long-term results of pulmonary thromboendarterectomy (PTE) in the chronic thromboembolic pulmonary hypertension (CTEPH) patients with unilateral main pulmonary artery occlusion.Methods We retrospectively analyzed the clinical data of 15 CTEPH patients with unilateral main pulmonary artery occlusion in Fuwai Hospital between 2004 and 2018. There were 11 males and 4 females aged 34.1±12.0 years at operation.Results The mean circulatory arrest was 31.1±12.1 minutes. The ICU stay was 5 (2-29) d. The hospital stay was 15 (8-29) d. There was no hospital death. There was a decline in systolic pulmonary artery pressures (sPAP, 69.9±27.9 mm Hg to 35.1±9.7 mm Hg, P=0.020) after surgery. On postoperative V/Q scan, only 6 patients (40.0%) had significant improvement in reperfusion (≥75% estimated) of the occluded lung. There was no death during the median observation period of 49 months follow-up, while 2 patients had recurrence of pulmonary embolism.Conclusion CTEPH patients with unilateral main pulmonary artery occlusion represent a challenging cohort. PTE is a curative resolution in both early- and long- term results, although there is a high requirement of perioperative management and a high risk of postoperative complications and rethrombosis.

Citation： SONG Wu, ZHONG Zhaoji, ZHENG Shanshan, SONG Yunhu, LIU Sheng. Chronic thromboembolic pulmonary hypertension: Outcomes of surgical effect in patients with unilateral main pulmonary artery occlusion. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(7): 813-818. doi: 10.7507/1007-4848.201911040 Copy

1.	Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J, 2019, 53(1): 1801913.
2.	Madani M, Mayer E, Fadel E, et al. Pulmonary endarterectomy. Patient selection, technical challenges, and outcomes. Ann Am Thorac Soc, 2016, 13(Suppl 3): S240-S247.
3.	Galie N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
4.	宋武, 刘盛, 邓隆, 等. 17 例肺动脉肉瘤的外科治疗. 中国循环杂志, 2019, 34(10): 999-1004.
5.	Kitcher A, Pretorius V, Kerr K, et al. Complete pulmonary artery occlusion from chronic thromboembolic disease: Outcomes following pulmonary thromboendarterectomy surgery. J Heart Lung Transplant, 2014, 32(Suppl 4): S54.
6.	Dorfmuller P, Gunther S, Ghigna MR, et al. Microvascular disease in chronic thromboembolic pulmonary hypertension: a role for pulmonary veins and systemic vasculature. Eur Respir J, 2014, 44(5): 1275-1288.
7.	Klok FA, Dzikowska-Diduch O, Kostrubiec M, et al. Derivation of a clinical prediction score for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. J Thromb Haemost, 2016, 14(1): 121-128.
8.	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.
9.	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(1): 97-103.
10.	Pepke-Zaba J, Hoeper MM, Humbert M. Chronic thromboembolic pulmonary hypertension: advances from bench to patient management. Eur Respir J, 2013, 41(1): 8-9.
11.	Moser KM, Bloor CM. Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest, 1993, 103(3): 685-692.
12.	Fadel E, Michel RP, Eddahibi S, et al. Regression of postobstructive vasculopathy after revascularization of chronically obstructed pulmonary artery. J Thorac Cardiovasc Surg, 2004, 127(4): 1009-1017.
13.	Hirsch AM, Moser KM, Auger WR, et al. Unilateral pulmonary artery thrombotic occlusion: is distal arteriopathy a consequence? Am J Respir Crit Care Med, 1996, 154(2 Pt 1): 491-496.
14.	Yi ES, Kim H, Ahn H, et al. Distribution of obstructive intimal lesions and their cellular phenotypes in chronic pulmonary hypertension. A morphometric and immunohistochemical study. Am J Respir Crit Care Med, 2000, 162(4 Pt 1): 1577-1586.
15.	Gan HL, Zhang JQ, Sun JC, et al. Preoperative transcatheter occlusion of bronchopulmonary collateral artery reduces reperfusion pulmonary edema and improves early hemodynamic function after pulmonary thromboendarterectomy. J Thorac Cardiovasc Surg, 2014, 148(6): 3014-3019.

1. Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J, 2019, 53(1): 1801913.
2. Madani M, Mayer E, Fadel E, et al. Pulmonary endarterectomy. Patient selection, technical challenges, and outcomes. Ann Am Thorac Soc, 2016, 13(Suppl 3): S240-S247.
3. Galie N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
4. 宋武, 刘盛, 邓隆, 等. 17 例肺动脉肉瘤的外科治疗. 中国循环杂志, 2019, 34(10): 999-1004.
5. Kitcher A, Pretorius V, Kerr K, et al. Complete pulmonary artery occlusion from chronic thromboembolic disease: Outcomes following pulmonary thromboendarterectomy surgery. J Heart Lung Transplant, 2014, 32(Suppl 4): S54.
6. Dorfmuller P, Gunther S, Ghigna MR, et al. Microvascular disease in chronic thromboembolic pulmonary hypertension: a role for pulmonary veins and systemic vasculature. Eur Respir J, 2014, 44(5): 1275-1288.
7. Klok FA, Dzikowska-Diduch O, Kostrubiec M, et al. Derivation of a clinical prediction score for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. J Thromb Haemost, 2016, 14(1): 121-128.
8. 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.
9. 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(1): 97-103.
10. Pepke-Zaba J, Hoeper MM, Humbert M. Chronic thromboembolic pulmonary hypertension: advances from bench to patient management. Eur Respir J, 2013, 41(1): 8-9.
11. Moser KM, Bloor CM. Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest, 1993, 103(3): 685-692.
12. Fadel E, Michel RP, Eddahibi S, et al. Regression of postobstructive vasculopathy after revascularization of chronically obstructed pulmonary artery. J Thorac Cardiovasc Surg, 2004, 127(4): 1009-1017.
13. Hirsch AM, Moser KM, Auger WR, et al. Unilateral pulmonary artery thrombotic occlusion: is distal arteriopathy a consequence? Am J Respir Crit Care Med, 1996, 154(2 Pt 1): 491-496.
14. Yi ES, Kim H, Ahn H, et al. Distribution of obstructive intimal lesions and their cellular phenotypes in chronic pulmonary hypertension. A morphometric and immunohistochemical study. Am J Respir Crit Care Med, 2000, 162(4 Pt 1): 1577-1586.
15. Gan HL, Zhang JQ, Sun JC, et al. Preoperative transcatheter occlusion of bronchopulmonary collateral artery reduces reperfusion pulmonary edema and improves early hemodynamic function after pulmonary thromboendarterectomy. J Thorac Cardiovasc Surg, 2014, 148(6): 3014-3019.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Chronic thromboembolic pulmonary hypertension: Outcomes of surgical effect in patients with unilateral main pulmonary artery occlusion

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