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Eur J Cardiothorac Surg 2001;19:771-776
© 2001 Elsevier Science NL
a Deptartment of Thoracic and Cardiovascular Surgery, University Hospital Homburg, Homburg, Germany
b Department of Pneumonology, University Hospital Homburg, Homburg, Germany
c Department of Medical Biometrics, University Hospital Homburg, Homburg, Germany
Received 10 October 2000; received in revised form 2 March 2001; accepted 14 March 2001.
Corresponding author. Tel.: +49-6841-162501; fax: +49-6841-162788
e-mail: chhjsc{at}med-rz.uni-sb.de
Objective: Pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension is a challenging procedure with a considerable mortality. The aim of this investigation was to identify risk factors influencing mortality and operative results. Methods: Between October 1995 and August 2000, 69 patients (age 54 years; 34 women; mean New York Heart Association (NYHA) stage 3.4) underwent PTE. The preoperative pulmonary vascular resistance (PVR) was 988±554 dynesxsxcm-5, mean pulmonary artery pressure 50±12 mmHg, right atrial pressure (RAP) 11.5±4 mmHg. Hospital mortality was 10.1% (n=7/69). Mean postoperative PVR on the 2nd day was 324±188 dynesxsxcm-5. Pulmonary angiography was reviewed for number of involved segments (mean 9.3±2) and bronchial arteries diameter (BAD; mean 4.6±1.6 mm). A univariate and multivariate analysis was performed to determine preoperative risk factors for hospital death and inadequate hemodynamic improvement. Results: By univariate analysis, mortality was influenced by age (P=0.04), right atrial pressure (P=0.009), NYHA (P=0.02) and the number of angiographically involved segments (P=0.02). Sex, left ventricular function, presence of coronary artery disease and bronchial artery diameter did not show correlation with mortality. Inadequate hemodynamic improvement in a dichotomized analysis (PVR
500 dynesxsxcm-5, n=11, and PVR <500 dynesxsxcm-5, n=58), assessed by univariate analysis, was significantly influenced by age (P=0.02), preoperative PVR (P=0.01), NYHA (P=0.002), RAP (P=0.02) and female sex (P=0.02). Multivariate analysis identified age (P=0.1), RAP (P=0.002) and female sex (P=0.007) as risk factors for inferior hemodynamic improvement. Conclusions: Preoperative parameters can be utilized to assess postoperative mortality and hemodynamic improvement after pulmonary thromboendarterectomy. Patient age and clinical deterioration of pulmonary hypertension are considerable preoperative factors influencing hospital mortality. Inadequate postoperative hemodynamic improvement is affected by severity of disease and female sex.
Key Words: Chronic pulmonary thromboembolism • Pulmonary hypertension • Pulmonary thromboendarterectomy
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