Ishida Keiichi, Masuda Masahisa
Department of Cardiovascular Surgery, National Hospital Organization Chiba Medical Center, Tsubakimori 4-1-2, Chuouku, Chiba 260-8606, Japan.
Asian Cardiovasc Thorac Ann. 2007 Jun;15(3):229-33. doi: 10.1177/021849230701500311.
Pulmonary thromboendarterectomy is a curative surgical procedure for chronic thromboembolic pulmonary hypertension. The aim of this study was to clarify whether severe hemodynamic compromise affects surgical outcome. We studied 19 patients who underwent pulmonary thromboendarterectomy and compared 11 with pulmonary vascular resistance < 1,000 dyne x s x cm(-5) (group 1) and 8 with pulmonary vascular resistance > 1,000 dyne x s x cm(-5) (group 2). Mean pulmonary artery pressure and pulmonary vascular resistance decreased significantly after surgery in both groups. The incidence of postoperative complications did not differ between groups; however, one patient in group 2 died of multiorgan failure. The overall mortality rate was 5.3%, and the rate in group 2 was 13%. Our results indicate that preoperative hemodynamic compromise does not affect surgical outcome. Patients with high pulmonary vascular resistance can be treated effectively by thromboendarterectomy, with acceptable morbidity and mortality.
肺动脉血栓内膜剥脱术是治疗慢性血栓栓塞性肺动脉高压的一种根治性外科手术。本研究的目的是阐明严重的血流动力学损害是否会影响手术结果。我们研究了19例行肺动脉血栓内膜剥脱术的患者，并将11例肺血管阻力<1000达因·秒·厘米⁻⁵的患者分为第1组，8例肺血管阻力>1000达因·秒·厘米⁻⁵的患者分为第2组。两组患者术后平均肺动脉压和肺血管阻力均显著下降。两组术后并发症发生率无差异；然而，第2组有1例患者死于多器官功能衰竭。总死亡率为5.3%，第2组的死亡率为13%。我们的结果表明，术前血流动力学损害不影响手术结果。肺血管阻力高的患者可通过血栓内膜剥脱术得到有效治疗，其发病率和死亡率均可接受。
