慢性血栓栓塞性肺动脉高压患者的外科治疗和结局：国际前瞻性登记研究结果。
Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry.
机构信息
Kerckhoff Heart and Lung Center, Bad Nauheim, Germany.
出版信息
J Thorac Cardiovasc Surg. 2011 Mar;141(3):702-10. doi: 10.1016/j.jtcvs.2010.11.024.
OBJECTIVE
Pulmonary endarterectomy is a curative surgical treatment option for the majority of patients with chronic thromboembolic pulmonary hypertension. The current surgical management and postoperative outcome of patients enrolled in an international registry on chronic thromboembolic pulmonary hypertension were investigated.
METHODS
The registry included newly diagnosed (≤6 months) consecutive patients with chronic thromboembolic pulmonary hypertension from February 2007 to January 2009.
RESULTS
A total of 679 patients were registered from 1 Canadian and 26 European centers, of whom 386 (56.8%) underwent surgery. The median age of patients undergoing surgery was 60 years, and 54.1% were male. Previous pulmonary embolism was confirmed for 79.8% of patients. Perioperative complications occurred in 189 patients (49.2%): infection (18.8%), persistent pulmonary hypertension (16.7%), neurologic (11.2%) or bleeding (10.2%) complications, pulmonary reperfusion edema (9.6%), pericardial effusion (8.3%), need for extracorporeal membrane oxygenation (3.1%), and in-hospital mortality due to perioperative complications (4.7%). Documented 1-year mortality was 7%. Preoperative exercise capacity was predictive of 1-year mortality. Postoperative pulmonary vascular resistance predicted in-hospital and 1-year mortality. In patients evaluated within 1 year after surgery, the median pulmonary vascular resistance had decreased from 698 to 235 dyn x s x cm(-5) (95% confidence limit, 640-874 and 211-255, respectively, n = 70) and the median 6-minute walk distance had increased from 362 to 459 m (95% confidence limit, 340-399 and 440-473, respectively, n = 168). New York Heart Association functional class improved with most patients progressing from class III/IV to class I/II.
CONCLUSIONS
Pulmonary endarterectomy is associated with a low in-hospital mortality rate and improvements in hemodynamics and exercise capacity.
目的
肺血管内膜切除术是治疗大多数慢性血栓栓塞性肺动脉高压患者的一种有治愈可能的手术治疗选择。本研究旨在调查一项国际慢性血栓栓塞性肺动脉高压注册研究中纳入的患者的当前手术治疗管理和术后结局。
方法
该注册研究纳入了 2007 年 2 月至 2009 年 1 月期间来自加拿大 1 个中心和欧洲 26 个中心的新诊断（≤6 个月）的连续慢性血栓栓塞性肺动脉高压患者。
结果
该研究共纳入了来自 1 个加拿大中心和 26 个欧洲中心的 679 例患者，其中 386 例（56.8%）接受了手术治疗。手术患者的中位年龄为 60 岁，54.1%为男性。79.8%的患者既往有肺动脉栓塞史。189 例（49.2%）患者发生围手术期并发症：感染（18.8%）、持续性肺动脉高压（16.7%）、神经系统（11.2%）或出血（10.2%）并发症、肺再灌注水肿（9.6%）、心包积液（8.3%）、需要体外膜肺氧合（3.1%）和围手术期并发症导致的院内死亡率（4.7%）。术后 1 年死亡率为 7%。术前运动能力可预测术后 1 年死亡率。术后肺血管阻力可预测院内和术后 1 年死亡率。在术后 1 年内接受评估的患者中，肺血管阻力中位数从 698dyn·s·cm^-5 降至 235dyn·s·cm^-5（95%置信区间分别为 640-874 和 211-255，n=70），6 分钟步行距离中位数从 362m 增加至 459m（95%置信区间分别为 340-399 和 440-473，n=168）。大多数患者的纽约心脏协会心功能分级从 III/IV 级改善至 I/II 级。
结论
肺血管内膜切除术的院内死亡率较低，并可改善血液动力学和运动能力。
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