HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hitoshi Ogino Motomi Ando Hitoshi Matsuda Kenji Minatoya Soichiro Kitamura Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ogino, H. Articles by Kitamura, S. Search for Related Content PubMed PubMed Citation Articles by Ogino, H. Articles by Kitamura, S. Related Collections Great vessels

Ann Thorac Surg 2006;82:630-636
© 2006 The Society of Thoracic Surgeons

---

Original article: Cardiovascular

Japanese Single-Center Experience of Surgery for Chronic Thromboembolic Pulmonary Hypertension

^a Department of Cardiovascular Surgery, National Cardiovascular Center
^b Department of Cardiology, National Cardiovascular Center
^c Department of Thoracic Surgery, Fujita Health University

Accepted for publication March 27, 2006.

^_* Address correspondence to Dr Ogino, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan (Email: hogino{at}hsp.ncvc.go.jp).

BACKGROUND: We review the outcome of surgery for chronic thromboembolic pulmonary hypertension (CTEPH).

METHODS: Between 1995 and 2004, 88 patients underwent surgery for CTEPH. Mean pulmonary artery pressure and pulmonary vascular resistance were 46 mm Hg (range, 23 to 70 mm Hg) and 986 dynes · sec^–1 · cm^–5 (298 to 2,231 dynes · sec^–1 · cm^–5). The pulmonary artery lesion was proximally located in 51 patients, subsegmental in 34 patients, and peripheral in 3 patients. Pulmonary endarterectomy was performed using cycles of 15-minute intermittent circulatory arrest followed by 10-minute reperfusion at 16°C to 18°C.

RESULTS: The median durations of circulatory arrest, cardiopulmonary bypass, and surgery were 58, 217, and 355 minutes, respectively. Percutaneous extracorporeal membrane oxygenation was used in 8 patients (9.1%) who had difficulty being weaning from cardiopulmonary bypass. Three recent patients for whom this was performed promptly were weaned and survived. There were 7 hospital deaths (8.0%, including 6 30-day deaths) from pulmonary bleeding in 2 patients, residual pulmonary hypertension in 3, rupture of bulla in 1, and empyema in 1. In the 81 survivors, mean pulmonary artery pressure and pulmonary vascular resistance fell significantly after surgery (p < 0.0001, each case). Age more than 60 years was a risk factor for hospital mortality on multivariate analysis. Although distal pulmonary artery disease including subsegmental and peripheral lesions was not a significant risk factor for mortality, it did influence patient recovery: the frequency of percutaneous extracorporeal membrane oxygenation was higher and hemodynamic improvement less pronounced in patients with distal disease. The actuarial survival rate was 90.7% at 3 years and 86.4% at 5 years. None of the patients have suffered recurrence. The event-free rate was 97.1% at 3 years and 93.5% at 5 years. Of the 68 patients surviving for more than 1 year after surgery, 67.6% were successfully weaned from home oxygen therapy and 13.2% required only occasional use of oxygen.

CONCLUSIONS: Pulmonary endarterectomy can be safely performed with relatively low mortality and favorable prognosis with long-term survival, although it should be performed carefully for patients with distal disease.

This article has been cited by other articles:

				K. Ishida, M. Masuda, H. Tanaka, M. Imamaki, M. Katsumata, T. Maruyama, and M. Miyazaki Mid-term results of surgery for chronic thromboembolic pulmonary hypertension Interactive CardioVascular and Thoracic Surgery, October 1, 2009; 9(4): 626 - 629. [Abstract] [Full Text] [PDF]

				N. Saouti, W. J. Morshuis, R. H. Heijmen, and R. J. Snijder Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a single institution experience Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 947 - 952. [Abstract] [Full Text] [PDF]

				M. Berman, S. Tsui, A. Vuylsteke, A. Snell, S. Colah, R. Latimer, R. Hall, J. E. Arrowsmith, J. Kneeshaw, A. A. Klein, et al. Successful Extracorporeal Membrane Oxygenation Support After Pulmonary Thromboendarterectomy Ann. Thorac. Surg., October 1, 2008; 86(4): 1261 - 1267. [Abstract] [Full Text] [PDF]

				D. H. Freed, B. M. Thomson, S. S.L. Tsui, J. J. Dunning, K. K. Sheares, J. Pepke-Zaba, and D. P. Jenkins Functional and haemodynamic outcome 1 year after pulmonary thromboendarterectomy Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 525 - 530. [Abstract] [Full Text] [PDF]

				A. G. Corsico, A. M. D'Armini, I. Cerveri, C. Klersy, E. Ansaldo, R. Niniano, E. Gatto, C. Monterosso, M. Morsolini, S. Nicolardi, et al. Long-term Outcome after Pulmonary Endarterectomy Am. J. Respir. Crit. Care Med., August 15, 2008; 178(4): 419 - 424. [Abstract] [Full Text] [PDF]

				H. Matsuda, H. Ogino, K. Minatoya, H. Sasaki, N. Nakanishi, S. Kyotani, J. Kobayashi, T. Yagihara, and S. Kitamura Long-term recovery of exercise ability after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ann. Thorac. Surg., October 1, 2006; 82(4): 1338 - 1343. [Abstract] [Full Text] [PDF]