Freed Darren H, Thomson Bruce M, Tsui Steven S L, Dunning John J, Sheares Karen K, Pepke-Zaba Joanna, Jenkins David P
Papworth Hospital, Papworth Everard, Cambridge CB23 3RE, UK.
Eur J Cardiothorac Surg. 2008 Sep;34(3):525-9; discussion 529-30. doi: 10.1016/j.ejcts.2008.04.018. Epub 2008 May 22.
Chronic thromboembolic pulmonary hypertension (CTEPH) results in severe symptoms and impaired survival. Pulmonary thromboendarterectomy (PTE) is considered the gold standard treatment. Many units have reported excellent early results post PTE, but there is less information on whether benefit is sustained. We sought to determine the medium-term functional and haemodynamic outcome for patients following PTE and the longer-term survival after discharge from hospital.
Data were collected prospectively on all patients who underwent PTE in the UK between 1997 and June 2006. Patients were reassessed at 3 and 12 months after operation. Follow-up over time was assessed using repeated measures ANOVA, the Friedman test or Wilcoxon signed ranks test as appropriate.
Two hundred and twenty-nine patients underwent PTE, survived to hospital discharge, and completed follow-up. At 3 months following operation, there was a significant reduction in mean pulmonary artery pressure (47+/-14 to 25+/-14mmHg, p<0.001), a significant increase in cardiac index (1.9+/-0.7 to 2.5+/-0.6l/minm(2), p<0.001) and a significant increase in 6-min walk distance (269+/-123 to 375+/-104m, p<0.001). At 12-month follow-up, the haemodynamic improvements were sustained and there was a further increase in 6-min walk distance (375+/-104 to 392+/-108m, p=0.004). NYHA class was significantly reduced at 3 months, with the improvement sustained at 12 months. Conditional survival following discharge from hospital was 92.5% at 5 years and 88.3% at 10 years.
PTE is a very effective therapy for CTEPH. This is the first report from a continuous national series to fully characterise haemodynamic and functional outcome 1 year after PTE. Patients enjoy continued improvement in haemodynamic status that translates into better exercise capacity, reduced symptoms and excellent survival.
慢性血栓栓塞性肺动脉高压（CTEPH）会导致严重症状并影响生存。肺动脉血栓内膜剥脱术（PTE）被视为金标准治疗方法。许多单位报告了PTE术后出色的早期结果，但关于获益是否能持续的信息较少。我们试图确定PTE术后患者的中期功能和血流动力学结果以及出院后的长期生存率。
前瞻性收集了1997年至2006年6月在英国接受PTE的所有患者的数据。患者在术后3个月和12个月进行重新评估。根据情况使用重复测量方差分析、Friedman检验或Wilcoxon符号秩检验评估随时间的随访情况。
229例患者接受了PTE，存活至出院并完成随访。术后3个月，平均肺动脉压显著降低（47±14至25±14mmHg，p<0.001），心脏指数显著增加（1.9±0.7至2.5±0.6l/minm(2)，p<0.001），6分钟步行距离显著增加（269±123至375±104m，p<0.001）。在12个月随访时，血流动力学改善得以维持，6分钟步行距离进一步增加（375±104至392±108m，p=0.004）。纽约心脏协会（NYHA）分级在3个月时显著降低，在12个月时改善得以维持。出院后的条件生存率在5年时为92.5%，在10年时为88.3%。
PTE是治疗CTEPH的非常有效的疗法。这是来自一个连续全国系列的首份报告，全面描述了PTE术后1年的血流动力学和功能结果。患者的血流动力学状态持续改善，这转化为更好的运动能力、减轻的症状和出色的生存率。
