Matsuda Hitoshi, Ogino Hitoshi, Minatoya Kenji, Sasaki Hiroaki, Nakanishi Norifumi, Kyotani Shingo, Kobayashi Junjiro, Yagihara Toshikatsu, Kitamura Soichiro
Department of Cardio-Vascular Surgery, National Cardio-Vascular Center, Suita, Osaka, Japan.
Ann Thorac Surg. 2006 Oct;82(4):1338-43; discussion 1343. doi: 10.1016/j.athoracsur.2006.03.105.
The exercise capacity of patients with thromboembolic pulmonary hypertension was investigated to clarify the long-term effects of pulmonary endarterectomy. This capacity was assessed by measuring cardiopulmonary factors during cardiopulmonary exercise testing at the maximal level of exercise and a 6-minute walk test at the submaximal level. Their survival rate was also determined.
We conducted a retrospective review of the clinical records of 102 patients who underwent pulmonary endarterectomy (63 women; median age, 53 years).
Eight (7.8%) hospital mortalities were encountered. Three late mortalities due to fulminant hepatitis, breast cancer, and pneumonia in a patient under steroid therapy were unrelated to pulmonary endarterectomy. The actual survival rate including hospital mortalities was 90.9% at 3 years and 84.0% at 5 years. All hemodynamic measurements significantly improved and reached a plateau 1-month after endarterectomy. The cardiopulmonary exercise test at the maximal exercise level revealed that peak oxygen uptake (V(O2)) baseline was 13.8 +/- 3.2 mL/min/kg, and at 1-month was 16.2 +/- 4.2 mL/min/kg (p = 0.0015) and ventilatory response to carbon dioxide production (V(E)-V(CO2)) slope baseline was 46.5 +/- 8.4 mL/min/kg, and at 1-month was 39.9 +/- 7.4 (p = 0.0006), which gradually and significantly improved during the first year after endarterectomy (peak V(O2), 19.9 +/- 3.9 mL/min/kg [p < 0.0001] and V(E)-V(CO2) slope, 33.2 +/- 5.4 mL/min/kg [p <0.0001]). The 6-minute walk test, which reflects the systemic response at the submaximal level of functional capacity, showed that the walking distance gradually and significantly increased for up to 1 year after endarterectomy (baseline, 358 +/- 102 meters [m]; at 1-month, 433 +/- 105 m; and at 1-year, 490 +/- 80 m [p < 0.0001]) and then reached a plateau.
After pulmonary endarterectomy, the hemodynamic recovery occurred immediately, and the patients' exercise capacity improved during the year. The 6-minute walk test was a good indicator to assess the recovery of exercise capacity.
对血栓栓塞性肺动脉高压患者的运动能力进行研究，以阐明肺动脉内膜剥脱术的长期效果。通过在最大运动水平的心肺运动测试和次最大运动水平的6分钟步行测试中测量心肺因素来评估这种能力。还确定了他们的生存率。
我们对102例行肺动脉内膜剥脱术的患者（63例女性；中位年龄53岁）的临床记录进行了回顾性分析。
发生8例（7.8%）医院死亡病例。3例晚期死亡分别因暴发性肝炎、乳腺癌以及1例接受类固醇治疗患者的肺炎，与肺动脉内膜剥脱术无关。包括医院死亡病例在内的实际生存率在3年时为90.9%，5年时为84.0%。所有血流动力学测量值均显著改善，并在内膜剥脱术后1个月达到平台期。最大运动水平的心肺运动测试显示，峰值摄氧量（V（O2））基线为13.8±3.2 mL/min/kg，1个月时为16.2±4.2 mL/min/kg（p = 0.0015），对二氧化碳产生的通气反应（V（E）-V（CO2））斜率基线为46.5±8.4 mL/min/kg，1个月时为39.9±7.4（p = 0.0006），在内膜剥脱术后第一年逐渐且显著改善（峰值V（O2），19.9±3.9 mL/min/kg [p < 0.0001]，V（E）-V（CO2）斜率，33.2±5.4 mL/min/kg [p <0.0001]）。反映次最大功能能力水平全身反应的6分钟步行测试显示，步行距离在内膜剥脱术后长达1年逐渐且显著增加（基线，358±102米[m]；1个月时，433±105 m；1年时，490±80 m [p < 0.0001]），然后达到平台期。
肺动脉内膜剥脱术后，血流动力学立即恢复，患者运动能力在1年内得到改善。6分钟步行测试是评估运动能力恢复的良好指标。
