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Dynamic Risk Stratification of Patient Long-Term Outcome After Pulmonary Endarterectomy: Results From the United Kingdom National Cohort.

ABSTRACT: BACKGROUND:Chronic thromboembolic pulmonary hypertension results from incomplete resolution of pulmonary emboli. Pulmonary endarterectomy (PEA) is potentially curative, but residual pulmonary hypertension following surgery is common and its impact on long-term outcome is poorly understood. We wanted to identify factors correlated with poor long-term outcome after surgery and specifically define clinically relevant residual pulmonary hypertension post-PEA. METHODS AND RESULTS:Eight hundred eighty consecutive patients (mean age, 57 years) underwent PEA for chronic thromboembolic pulmonary hypertension. Patients routinely underwent detailed reassessment with right heart catheterization and noninvasive testing at 3 to 6 months and annually thereafter with discharge if they were clinically stable at 3 to 5 years and did not require pulmonary vasodilator therapy. Cox regressions were used for survival (time-to-event) analyses. Overall survival was 86%, 84%, 79%, and 72% at 1, 3, 5, and 10 years for the whole cohort and 91% and 90% at 1 and 3 years for the recent half of the cohort. The majority of patient deaths after the perioperative period were not attributable to right ventricular failure (chronic thromboembolic pulmonary hypertension). At reassessment, a mean pulmonary artery pressure of ?30 mm?Hg correlated with the initiation of pulmonary vasodilator therapy post-PEA. A mean pulmonary artery pressure of ?38 mm?Hg and pulmonary vascular resistance ?425 dynes·s(-1)·cm(-5) at reassessment correlated with worse long-term survival. CONCLUSIONS:Our data confirm excellent long-term survival and maintenance of good functional status post-PEA. Hemodynamic assessment 3 to 6 months and 12 months post-PEA allows stratification of patients at higher risk of dying of chronic thromboembolic pulmonary hypertension and identifies a level of residual pulmonary hypertension that may guide the long-term management of patients postsurgery.

SUBMITTER: Cannon JE

PROVIDER: S-EPMC5860739 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Dynamic Risk Stratification of Patient Long-Term Outcome After Pulmonary Endarterectomy: Results From the United Kingdom National Cohort.

Cannon John E JE Su Li L Kiely David G DG Page Kathleen K Toshner Mark M Swietlik Emilia E Treacy Carmen C Ponnaberanam Anie A Condliffe Robin R Sheares Karen K Taboada Dolores D Dunning John J Tsui Steven S Ng Choo C Gopalan Deepa D Screaton Nicholas N Elliot Charlie C Gibbs Simon S Howard Luke L Corris Paul P Lordan James J Johnson Martin M Peacock Andrew A MacKenzie-Ross Robert R Schreiber Benji B Coghlan Gerry G Dimopoulos Kostas K Wort Stephen J SJ Gaine Sean S Moledina Shahin S Jenkins David P DP Pepke-Zaba Joanna J

Circulation 20160406 18

<h4>Background</h4>Chronic thromboembolic pulmonary hypertension results from incomplete resolution of pulmonary emboli. Pulmonary endarterectomy (PEA) is potentially curative, but residual pulmonary hypertension following surgery is common and its impact on long-term outcome is poorly understood. We wanted to identify factors correlated with poor long-term outcome after surgery and specifically define clinically relevant residual pulmonary hypertension post-PEA.<h4>Methods and results</h4>Eight ...[more]

PMID: 27052413

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Dataset Information

Dynamic Risk Stratification of Patient Long-Term Outcome After Pulmonary Endarterectomy: Results From the United Kingdom National Cohort.

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Dynamic Risk Stratification of Patient Long-Term Outcome After Pulmonary Endarterectomy: Results From the United Kingdom National Cohort.

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