SHORT-TERM OUTCOME AND PREDICTORS OF ADVERSE EVENTS FOLLOWING PULMONARY THROMBOENDARTERECTOMY

Pulmonary complications including hypoxemia, right heart failure, and prolonged ventilation may follow pulmonary thromboendarterectomy (PTE) performed via cardiopulmonary bypass (CPB) with deep hypothermic circ ulatory arrest. Seventeen adult patients have undergone PTE at the Uni versity of Maryland Medical System during the preceding 3 years. From these patients, clinical and hemodynamic parameters were tabulated pre -CPB, post-CPB, at admission to the intensive care unit (ICU), and pri or to discontinuation of invasive monitoring in the ICU. Data on anthr opometric variables, survival, and times of extracorporeal circulation , mechanical ventilation, and hospital stay were also collected. The m ean values for pulmonary arterial systolic and diastolic pressures and pulmonary vascular resistance (PVR) decreased significantly from pre- CPB values after PTE (all p < 0.05). Mild mixed acidosis present at IC U admission resolved prior to discharge (p = 0.002). The length of mec hanical ventilation time was positively correlated with the absolute p ost-CPB PVR and negatively correlated with the relative change in cent ral venous pressure (CVP) from pre-CPB to post-CPB values (r = 0.75, p = 0.037). Of the pre-CPB anthropometric variables, only body mass ind ex was significantly higher in nonsurvivors (p = 0.037). Pulmonary art ery pressures and vascular resistance fall significantly after PTE. A lower post-CPB PVR and a relatively decreased (i.e., from pre-CPB valu es) CVP predict reduced length of postoperative ventilation but not of the hospital stay. Mortality appears increased in patients with a lar ge body habitus.