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Ann Thorac Surg 2006;82:1338-1343
© 2006 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Long-Term Recovery of Exercise Ability After Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension

^a Department of Cardio-Vascular Surgery, National Cardio-Vascular Center, Suita, Japan
^b Department of Cardiology and Pulmonary Circulation, National Cardio-Vascular Center, Suita, Japan

Accepted for publication March 29, 2006.

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

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

BACKGROUND: The exercise capacity of patients with thromboembolic pulmonary hypertension was investigated to clarify the long-term effects of pulmonary endarterectomy. This capacity was assessed by measuring cardiopulmonary factors during cardiopulmonary exercise testing at the maximal level of exercise and a 6-minute walk test at the submaximal level. Their survival rate was also determined.

METHODS: We conducted a retrospective review of the clinical records of 102 patients who underwent pulmonary endarterectomy (63 women; median age, 53 years).

RESULTS: Eight (7.8%) hospital mortalities were encountered. Three late mortalities due to fulminant hepatitis, breast cancer, and pneumonia in a patient under steroid therapy were unrelated to pulmonary endarterectomy. The actual survival rate including hospital mortalities was 90.9% at 3 years and 84.0% at 5 years. All hemodynamic measurements significantly improved and reached a plateau 1-month after endarterectomy. The cardiopulmonary exercise test at the maximal exercise level revealed that peak oxygen uptake (V_O2) baseline was 13.8 ± 3.2 mL/min/kg, and at 1-month was 16.2 ± 4.2 mL/min/kg (p = 0.0015) and ventilatory response to carbon dioxide production (V_E-V_CO2) slope baseline was 46.5 ± 8.4 mL/min/kg, and at 1-month was 39.9 ± 7.4 (p = 0.0006), which gradually and significantly improved during the first year after endarterectomy (peak V_O2, 19.9 ± 3.9 mL/min/kg [p < 0.0001] and V_E-V_CO2 slope, 33.2 ± 5.4 mL/min/kg [p <0.0001]). The 6-minute walk test, which reflects the systemic response at the submaximal level of functional capacity, showed that the walking distance gradually and significantly increased for up to 1 year after endarterectomy (baseline, 358 ± 102 meters [m]; at 1-month, 433 ± 105 m; and at 1-year, 490 ± 80 m [p < 0.0001]) and then reached a plateau.

CONCLUSIONS: After pulmonary endarterectomy, the hemodynamic recovery occurred immediately, and the patients' exercise capacity improved during the year. The 6-minute walk test was a good indicator to assess the recovery of exercise capacity.

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