Pulmonary Thromboendarterectomy Experience at the Cleveland Clinic

Abstract

SESSION TITLE: Pulmonary Arterial Hypertension Posters II SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Pulmonary hypertension due to unresolved pulmonary emboli that narrow pulmonary arteries, known as chronic thromboembolic pulmonary hypertension (CTEPH), is a deadly disease that can be effectively treated with a complex surgical procedure called pulmonary thromboendarterectomy (PTE). The Cleveland Clinic has a multidisciplinary team dedicated to the evaluation and treatment of CTEPH patients. Here, we report our PTE experience. METHODS: Retrospective review of all patients who underwent PTE at the Cleveland Clinic. We report surgical volumes and hospital mortality. For recent cohorts, we report detailed demographic, clinical and hemodynamic data before and after PTE, as well as long term survival. RESULTS: Between 1995 and 2014, a total of 150 PTE surgeries were performed at the Cleveland Clinic. Between 1995 and 2010, there were a total of 86 PTEs with a hospital mortality rate of 11.6%. Between 2011 and 2014, we performed 64 PTE surgeries with a hospital mortality rate of 4.7%. Patients operated between 2011 and 2014 had the following baseline characteristics: median age 51 (range 21-81); 61% male; NYHA functional class II 18%, III 64% and IV 18%; median body mass index 31 (range 22 - 54); median six-minute walk distance 291 meters (interquartile range [IQR] 221, 384), median NT-proBNP 764 pg/mL (interquartile range 180, 2132). Pre and post PTE invasive hemodynamics were as follows: mean PAP 45 (IQR 39, 55) and 25 (IQR 22, 31) mmHg, cardiac index 2.2 (IQR 1.8, 2.6) and 2.9 (IQR 2.6, 3.3) L/min/m2, pulmonary vascular resistance 6.2 (IQR 4.9, 10.1) and 2.4 (IQR 1.8, 3.1) Wood units, respectively. For 70 CTEPH patients treated with PTE between 2009 and 2014, 5 -year survival was 87.4%, compared to 63.3% for 31 contemporary CTEPH patients treated medically (log-rank p = 0.04). CONCLUSIONS: PTE is the treatment of choice for CTEPH as it is associated with low operative mortality; dramatic improvements right heart hemodynamics and excellent long-term outcomes, even in patients with severe disease and co-morbidities such as obesity. CLINICAL IMPLICATIONS: There is a need for emerging centers with a dedicated team of specialists to effectively evaluate and treat patients with CTEPH. DISCLOSURE: Gustavo Heresi: Consultant fee, speaker bureau, advisory committee, etc.: Bayer Healthcare The following authors have nothing to disclose: Nicholas Smedira No Product/Research Disclosure Information