Short term outcomes and respiratory complications after pulmonary endarterectomy: results from a single Chinese center
10.3760/cma.j.cn112434-20200714-00337
- VernacularTitle:单中心肺动脉内膜剥脱术短期预后及呼吸系统并发症分析
- Author:
Chen LI
1
;
Junyu MA
;
Shupeng WANG
;
Xiaojing WU
;
Shanshan ZHAI
;
Desheng CHEN
;
Hui WANG
;
Yina WU
;
Zhenguo ZHAI
;
Yanan ZHEN
;
Jun DUAN
Author Information
1. 中日友好医院外科重症医学科，北京 100029
- Keywords:
Pulmonary endarterectomy;
Respiratory complication;
Reperfusion pulmonary edema;
Residual pulmonary hypertension
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2021;37(9):521-525
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the short term outcomes and postoperative respiratory complications of patients with chronic thromboembolic pulmonary hypertension(CTEPH) treated by pulmonary endarterectomy(PEA).Methods:45 consecutive CTEPH patients underwent PEA between December 2017 and January 2020 in our institution were enrolled, including 25 females and 20 males. The mean age of operation was 51.2(25-70) years old. 24(53.5%) patients were in New York Heart Association(NYHA) functional class Ⅲ-Ⅳ. The mean PVR before operation was 923(461-2 711) dyn·s·cm -5. All patients’ data were entered in a prospective database, divieded into patients with respiratory complications group(WRC)and without respiratory complications group(WORC). To assess risk factors for postoperative respiratory complications and its effect on short term outcomes. Results:There was a significant reduction in mPAP(from 37 mmHg to 20 mmHg) and PVR(from 923 dyn·s·cm -5 to 293 dyn·s·cm -5) in the entire group. The in-hospital mortality rate was 4.4%(2 cases), died due to postoperative cardiogenic circulatory failure, even with VA-ECMO treatment and mediastinal infection, respectively. Postoperative respiratory complications occurred in 32 patients(71.1%). The most common complications were reperfusion pulmonary edema 44.4%(20 cases) and residual pulmonary hypertension 11.1%(5 cases). The WRC group showed a tendency to have longer periods of mechanical ventilation, longer ICU stays and more ICU costs. Independent predictors of postoperative respiratory complications were time from symptom onset to PEA>36 months( OR=12.2, 95% CI: 2.1-70.7, P=0.005)and six-minute walking distance<300 m( OR=12.6, 95% CI: 1.1-138.0, P=0.0038). Conclusion:Pulmonary endarterectomy is an effective and safe treatment for CTEPH. Postoperative respiratory complications were mainly determined by symptom onset time and pre-operative status. Patients with CTEPH should consider PEA surgery early.
