PULMONARY THROMBOENDARTERECTOMY OUTCOMES IN PATIENTS WITH PRIOR STERNOTOMY

Abstract

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Pulmonary thromboendarterectomy (PTE) remains the procedure of choice for the treatment of CTEPH. However, registry data suggest more than 1/3 of CTEPH patients are deemed inoperable due distal location of disease and/or comorbidities. There have been no publications of risks and outcomes in PTE patients with prior sternotomy. METHODS: We performed a retrospective review of the UCSD CTEPH quality improvement database, including all patients who underwent PTE at our institution from December 2005 to June 2019. Complete pre-and post-op data was available on 1744 PTE patients of which 105 patients were identified as having a previous sternotomy. Of those 105 patients with prior sternotomy, 42 had previous PTE and 63 had undergone other cardiac procedures. We compared these 63 patients undergoing re-entry sternotomy (Re-entry) to 1639 PTE patients without a history of prior sternotomy (controls). RESULTS: The most common cause for initial sternotomy in Re-entry patients was RA/RV clot (n=25) followed by previous CABG (n=16) and valve replacements including mitral (n = 4) and tricuspid valve (n=2). Age and preoperative mPA (39.5 vs 42.4 mmHg, p = 0.7) and PVR (514 vs 634 dynes.sec.cm-5, p= 0.27) were similar between Re-entry and controls. UCSD Level of disease, CPBP times, and number of additional procedures at the time of PTE were similar between Re-entry and controls. Re-entry sternotomy subjects had prolonged circulatory arrest times (46 ± 18 vs 36 ± 14 minutes, p=0.0007) compared to controls. Postoperative hemodynamics were comparable between Re-entry and control groups: mPA (23.8 vs 24.1 mmHg, p = 0.999) and PVR (223 vs 238 dynes.sec.cm-5, p = 0.997). Postoperatively, Re-entry subjects were more likely to require re-intubation (3.3% vs 9.5%, p=0.009), have post-op bleeding complications (11.8% vs 20.6%, p=0.045) with a trend towards increased need to return to OR (4.6% vs 9.5%, p = 0.076). Mortality was higher in the Re-entry group, but not statistically different from controls (4.8% vs 2.1%, p = 0.15). Causes of the 3 deaths for the Re-entry group included recurrent pulmonary and systemic artery thromboses (1), cardiogenic shock from acute occlusion of a pre-existing LIMA-LAD graft (1), and mediastinal hemorrhage (1). The ventilator days, ICU stay, and total hospital length of stay did not differ significantly between the two groups. CONCLUSIONS: Patients who have undergone previous sternotomy prior to PTE experience significant hemodynamic improvement with similar ventilator, ICU, and total post-operative hospital days compared to patients without prior sternotomy. However, re-entry sternotomy was associated with a higher risk of bleeding and re-intubation. CLINICAL IMPLICATIONS: Despite the increased risk, selected patients with a history of prior sternotomy have excellent outcomes and should still be considered for PTE surgery. DISCLOSURES: No relevant relationships by Anna Astashchanka, source=Web Response No relevant relationships by Timothy Fernandes, source=Web Response research support relationship with Bayer HealthCare Please note: >$100000 Added 05/21/2020 by Kim Kerr, source=Web Response, value=Grant/Research Support Consultant relationship with Actelion Please note: $1001 - $5000 Added 05/21/2020 by Kim Kerr, source=Web Response, value=Consulting fee Consultant relationship with Actelion Please note: $5001 - $20000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Consulting fee Consultant relationship with Bayer Please note: $5001 - $20000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Actelion Please note: $1001 - $5000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Bayer Please note: $1001 - $5000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Honoraria Scientific Medical Advisor relationship with Gossamer Bio Please note: $5001 - $20000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Grant/Research Support Scientific Medical Advisor relationship with Sonivie Please note: $5001 - $20000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Grant/Research Support Scientific Medical Advisor relationship with United Therapeutics Please note: $1001 - $5000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Consulting fee Scientific Medical Advisor relationship with United Therapeutics Please note: $1001 - $5000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Consulting fee Removed 05/20/2020 by Nick Kim, source=Web Response No relevant relationships by Michael Madani, source=Web Response Consultant relationship with Actelion LLC Please note: $20001 - $100000 Added 05/29/2020 by Demosthenes Papamatheakis, source=Web Response, value=Honoraria Principal Investigator relationship with Actelion Please note: $1-$1000 Added 05/30/2020 by David Poch, source=Web Response, value=No compensation Principal Investigator relationship with United Therapeutics Please note: $1-$1000 Added 05/30/2020 by David Poch, source=Web Response, value=No compensation Principal Investigator relationship with Reatta Please note: $1-$1000 Added 05/30/2020 by David Poch, source=Web Response, value=No compensation Principal Investigator relationship with Phasebio Please note: $1-$1000 Added 05/30/2020 by David Poch, source=Web Response, value=No compensation Principal Investigator relationship with Acceleron Please note: $1-$1000 Added 05/30/2020 by David Poch, source=Web Response, value=No compensation No relevant relationships by Victor Pretorius, source=Web Response