Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
Chest. 2011 Jul;140(1):34-41. doi: 10.1378/chest.10-1263. Epub 2010 Dec 16.
Despite a major reduction in pulmonary vascular resistance (PVR), patients with chronic thromboembolic pulmonary hypertension (CTEPH) do not always return to functional New York Heart Association (NYHA) class I after pulmonary endarterectomy (PEA). We hypothesized that residual abnormal compliance (Cp) after PEA is associated with incomplete functional recovery despite major improvement in PVR.
The Cp of 34 consecutive patients with CTEPH was assessed before and after PEA. Cp was defined as stroke volume over pulse pressure and was divided into three groups: < 2.0 mL/mm Hg, 2.0 to 3.9 mL/mm Hg, and ≥ 4 mL/mm Hg. To establish predicted Cp after PEA, we collected an age- and gender-matched control group.
Before PEA, Cp was < 2.0 mL/mm Hg in 82% (n = 28) of the patients. After PEA, Cp improved to 2.0 to 3.9 mL/mm Hg in 11 patients and to ≥ 4.0 mL/mm Hg in 14 patients. Residual Cp < 2.0 mL/mm Hg was associated with delayed extubation and prolonged hospital stay. At 3 months' follow-up, 13 patients (93%) with postoperative Cp ≥ 4.0 mL/mm Hg returned to NYHA class I, whereas 45% with Cp of 2.0 to 3.9 mL/mm Hg and 25% with Cp < 2.0 mL/mm Hg returned to NYHA class I. In multivariate analysis, postoperative Cp ≥ 4.0 mL/mm Hg was the only predictor of functional recovery to NYHA class I. The group of patients with postoperative Cp ≥ 4.0 mL/mm Hg was also the only group to achieve hemodynamic parameters similar to those of their matched control subjects.
Postoperative Cp is an important predictor of recovery after PEA. Residual vascular stiffness after PEA can be associated with persistent functional limitation and lack of complete remodeling of the right ventricle.
尽管肺血管阻力（PVR）显著降低，但慢性血栓栓塞性肺动脉高压（CTEPH）患者在肺动脉内膜剥脱术（PEA）后并不总是能恢复到纽约心脏协会（NYHA）功能Ⅰ级。我们假设 PEA 后残余异常顺应性（Cp）与 PVR 显著改善后功能恢复不完全有关。
34 例 CTEPH 患者在 PEA 前后评估 Cp。Cp 定义为每搏量除以脉搏压，并分为三组：<2.0 mL/mm Hg、2.0 至 3.9 mL/mm Hg 和≥4.0 mL/mm Hg。为了建立 PEA 后的预测 Cp，我们收集了年龄和性别匹配的对照组。
PEA 前，82%（n=28）的患者 Cp<2.0 mL/mm Hg。PEA 后，11 例患者 Cp 改善至 2.0 至 3.9 mL/mm Hg，14 例患者 Cp 改善至≥4.0 mL/mm Hg。残余 Cp<2.0 mL/mm Hg 与延迟拔管和延长住院时间有关。在 3 个月的随访中，13 例（93%）术后 Cp≥4.0 mL/mm Hg 的患者恢复到 NYHA Ⅰ级，而 Cp 为 2.0 至 3.9 mL/mm Hg 的患者中 45%和 Cp<2.0 mL/mm Hg 的患者中 25%恢复到 NYHA Ⅰ级。多变量分析显示，术后 Cp≥4.0 mL/mm Hg 是恢复至 NYHA Ⅰ级的唯一预测因素。术后 Cp≥4.0 mL/mm Hg 的患者组也是唯一一组达到与匹配对照组相似的血流动力学参数的患者组。
术后 Cp 是 PEA 后恢复的重要预测因素。PEA 后残余血管僵硬可与持续性功能受限和右心室不完全重塑有关。
