Hipertensión pulmonar tromboembólica crónica: tratamiento mediante tromboendarterectomía quirúrgica

Abstract

Background and objectives Pulmonary thromboendarterectomy (PTE) is considered the potential curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We analysed the results of the PTE application in our institution. Patients and methods From February 1996 to December 2007, 30 patients with CTEPH underwent video-assisted PTE. Preoperative hemodynamic data were: systolic pulmonary artery pressure (SPAP) 87±17 mmHg, mean pulmonary artery pressure (MPAP) 51±11 mmHg, pulmonary total resistance 1067±485 dynes·s·cm –5, pulmonary vascular resistance 873±389 dynes·s·cm –5 and cardiac index 2.2±0.5 l/min/m 2. We analysed the influence of several factors on hospital mortality and survival, and we performed partial analysis of mortality since 2004. Results PTE resulted in significant improvements in SPAP ( P<0.001), MPAP ( P=0.001) and cardiac index ( P<0.001). Hospital mortality was 17% (5/30) (95% confidence interval, 6%-35%). From 2004, it dropped to 5% (1/20) (95% confidence interval, 0%-25%). Hospital mortality was influenced by preoperative pulmonary total resistance, preoperative pulmonary vascular resistance, postoperative SPAP, reduction of SPAP, reduction of MPAP, reperfusion pulmonary oedema and residual postoperative pulmonary hypertension ( P=0.036; P=0.018; P=0.013; P=0.050; P=0.050; P=0.030; P=0.045). Survival after PTE, including hospital mortality, was 76±9% at 10 years. Through long-term follow-up, functional status ( P=0.001), 6 min walking distance ( P=0.001), end-diastolic right ventricle size ( P<0.001), and tricuspid regurgitation ( P<0.001) significantly improved. Conclusions PTE effectively reduces pulmonary hypertension and offers CTEPH patients a substantial improvement in survival and quality of life.