Division of Cardiovascular and Thoracic Surgery, University of California San Diego Medical Center, San Diego, California, USA.
Ann Thorac Surg. 2012 Jul;94(1):97-103; discussion 103. doi: 10.1016/j.athoracsur.2012.04.004. Epub 2012 May 23.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a known sequela of acute pulmonary embolic disease and yet remains underdiagnosed. Although nonsurgical options for patients with CTEPH have become increasingly available, including pulmonary artery hypertensive medical therapy, surgical endarterectomy provides the most appropriate intervention as a potential cure for this debilitating disorder. This article summarizes the most recent outcomes of pulmonary endarterectomy at a single institution over the past 12 years, with emphasis on the surgical approach to segmental-level chronic thromboembolic disease.
More than 2,700 pulmonary endarterectomy operations have been performed at the University of California, San Diego Medical Center. Because of recent changes in the patient population and in surgical results, 1,500 patients with symptomatic chronic thromboembolic disease who underwent pulmonary endarterectomy between March 1999 and December 2010 were analyzed. The outcomes for the more recent 500 patients, compared with the previous 1,000 were studied.
In-hospital mortality for the cohort of 1,000 patients (group 1) was 5.2% compared with 2.2% for the last 500 operations (group 2) (p < 0.01). There was no mortality in the last 260 consecutive patients undergoing isolated pulmonary endarterectomy. More patients presented with segmental type III disease in the more recent 500 patients (21.4% versus 13.1%; p < 0.001). Between the 2 patient groups, there was a comparable decline in pulmonary vascular resistance (PVR) (group 1: 861.2 ± 446.2 to 94.8 ± 204.2 dynes/sec/cm(-5); group 2: 719.0 ± 383.2 to 253.4 ± 148.6 dynes/sec/cm(-5)) and mean pulmonary artery (PA) pressures (group 1: 46.1 ± 11.4 to 28.7 ± 10.1 mm Hg; group 2: 45.5 ± 11.6 to 26.0 ± 8.4 mm Hg) after endarterectomy.
Despite a patient population with more distal disease, results continue to improve. Pulmonary endarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement, with favorable outcomes achievable even in patients with distal segmental-level chronic thromboembolic disease.
慢性血栓栓塞性肺动脉高压（CTEPH）是急性肺栓塞疾病的已知后遗症，但仍未得到充分诊断。虽然 CTEPH 患者的非手术选择越来越多，包括肺动脉高压药物治疗，但作为这种使人虚弱的疾病的潜在治愈方法，肺动脉内膜切除术提供了最合适的干预措施。本文总结了过去 12 年在单一机构进行的肺动脉内膜切除术的最新结果，重点介绍了节段性慢性血栓栓塞疾病的手术方法。
加利福尼亚大学圣地亚哥医疗中心已经进行了超过 2700 例肺动脉内膜切除术。由于患者人群和手术结果的最近变化，对 1999 年 3 月至 2010 年 12 月期间接受肺动脉内膜切除术的 1500 例有症状的慢性血栓栓塞性疾病患者进行了分析。研究了最近 500 例患者与之前 1000 例患者的结果。
1000 例患者的住院死亡率为 5.2%，而最后 500 例手术的死亡率为 2.2%（p<0.01）。在最后 260 例连续接受单纯肺动脉内膜切除术的患者中没有死亡。最近的 500 例患者中更多的患者存在节段性 III 型疾病（21.4%对 13.1%；p<0.001）。在两组患者中，肺血管阻力（PVR）都有类似的下降（组 1：861.2±446.2 至 94.8±204.2 达因/秒/厘米-5；组 2：719.0±383.2 至 253.4±148.6 达因/秒/厘米-5）和平均肺动脉（PA）压（组 1：46.1±11.4 至 28.7±10.1 毫米汞柱；组 2：45.5±11.6 至 26.0±8.4 毫米汞柱）。
尽管患者群体的疾病更远处，但结果仍在不断改善。肺动脉内膜切除术治疗 CTEPH 患者可显著改善肺血流动力学，即使在患有远端节段性慢性血栓栓塞疾病的患者中也能取得良好的结果。
