Tscholl D, Langer F, Wendler O, Wilkens H, Georg T, Schäfers H J
Deptartment of Thoracic and Cardiovascular Surgery, University Hospital Homburg, Homburg, Germany.
Eur J Cardiothorac Surg. 2001 Jun;19(6):771-6. doi: 10.1016/s1010-7940(01)00686-8.
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.
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 dynes x s x cm(-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 dynes x s x cm(-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.
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 > or =500 dynes x s x cm(-5), n=11, and PVR < 500 dynes x s x cm(-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.
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.
慢性血栓栓塞性肺动脉高压的肺动脉血栓内膜剥脱术（PTE）是一项具有挑战性的手术，死亡率较高。本研究旨在确定影响死亡率和手术结果的危险因素。
1995年10月至2000年8月，69例患者（年龄54岁；34例女性；纽约心脏协会（NYHA）平均分级为3.4级）接受了PTE手术。术前肺血管阻力（PVR）为988±554达因×秒×厘米⁻⁵，平均肺动脉压50±12毫米汞柱，右心房压（RAP）11.5±4毫米汞柱。医院死亡率为10.1%（n = 7/69）。术后第2天的平均PVR为324±188达因×秒×厘米⁻⁵。回顾肺血管造影以确定受累节段数量（平均9.3±2个）和支气管动脉直径（BAD；平均4.6±1.6毫米）。进行单因素和多因素分析以确定医院死亡和血流动力学改善不足的术前危险因素。
单因素分析显示，死亡率受年龄（P = 0.04）、右心房压（P = 0.009）、NYHA分级（P = 0.02）和血管造影受累节段数量（P = 0.02）影响。性别、左心室功能、冠状动脉疾病的存在和支气管动脉直径与死亡率无相关性。在二分法分析中（PVR≥500达因×秒×厘米⁻⁵，n = 11；PVR < 500达因×秒×厘米⁻⁵，n = 58），单因素分析评估的血流动力学改善不足受年龄（P = 0.02）、术前PVR（P = 0.01）、NYHA分级（P = 0.002）、RAP（P = 0.02）和女性性别（P = 0.02）显著影响。多因素分析确定年龄（P = 0.1）、RAP（P = 0.002）和女性性别（P = 0.007）为血流动力学改善不佳的危险因素。
术前参数可用于评估肺动脉血栓内膜剥脱术后死亡率和血流动力学改善情况。患者年龄和肺动脉高压的临床恶化是影响医院死亡率的重要术前因素。术后血流动力学改善不足受疾病严重程度和女性性别的影响。
