MID-TERM RESULTS OF PULMONARY THROMBOENDARTERECTOMY FOR CHRONIC THROMBOEMBOLIC PULMONARY-HYPERTENSION

Background. In patients with chronic thromboembolic pulmonary hyperten sion, acute and striking decreases of pulmonary artery pressures and v ascular resistance can be achieved by pulmonary thromboendarterectomy. In this study, the long-term effects of pulmonary thromboendarterecto my on hemodynamic indices and right ventricular function were investig ated. Methods. Sixty-five patients (31 women and 34 men; mean age, 47 +/- 17 years; range, 19 to 69 years; New York Heart Association [NYHA] functional class II, n = 3; class III, n = 38; class IV, n = 24) were reassessed 13 to 48 months (mean, 27 months) after pulmonary thromboe ndarterectomy. measurements are reported as mean +/- standard deviatio n. Results. All patients reported a significant improvement of symptom s: 46 patients were in NYHA functional class 1, 16 patients in class I I, and 3 patients in class III. Mean pulmonary vascular resistance was significantly reduced compared with preoperative and postoperative va lues (preoperative: 1,015 +/- 454 dynes . s . cm(-5); postoperative: 3 22 +/- 154 dynes . s . cm(-5); follow-up: 198 +/- 72 dynes . s . cm(-5 ); p < 0.001 versus preoperative; p < 0.025 versus postoperative). Con comitantly, cardiac index was significantly increased compared with pr eoperative values (preoperative: 2.0 +/- 0.7 L . min(-1) . m(-2); foll ow-up: 2.9 +/- 0.5 L . min(-1) . m(-2); p < 0.001). Significant reduct ions of right ventricular dimensions and recovery of right ventricular function could be demonstrated radiologically and echocardiographical ly. In 3 patients (preoperative NYHA class IV, NYHA class III at follo w-up) with proven coagulation abnormalities, pulmonary vascular resist ance was moderately increased at follow-up compared with postoperative measurements. Conclusions. In patients with chronic thromboembolic pu lmonary hypertension, a persistent decrease of pulmonary vascular resi stance and improvement of right ventricular function and NYHA function al status can be achieved by pulmonary thromboendarterectomy.