Yanagisawa Ryoji, Kataoka Masaharu, Inami Takumi, Shimura Nobuhiko, Ishiguro Haruhisa, Fukuda Keiichi, Yoshino Hideaki, Satoh Toru
Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Int J Cardiol. 2014 Aug 1;175(2):285-9. doi: 10.1016/j.ijcard.2014.05.011. Epub 2014 May 16.
Percutaneous transluminal pulmonary angioplasty (PTPA) is a recently developed catheter-based therapy for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of the present study was to investigate the safety and efficacy of PTPA in elderly patients with CTEPH.
In all, 257 PTPA sessions in 70 patients (median age 63 years) were analyzed. Patients were divided into two groups according to age: (i) a younger group (<65 years; n=39); and (ii) an elderly group (≥65 years; n=31).
Hemodynamic improvements were comparable between the younger and elderly groups (63.1% vs. 68.2% decrease in pulmonary vascular resistance, respectively; P>0.05). The median length of stay in the intensive care unit after each session (1.0 vs. 1.0 days) and in hospital per session (9.2 vs. 9.4 days) was similar between the two groups (P>0.05 for all). The prevalence of reperfusion pulmonary edema (23.4% vs. 26.3% across all sessions) and other complications, such as contrast dye-induced nephropathy (0% vs. 2.0%), infection (0% vs. 0%), and neurological complications (0% vs. 1.0%), was comparable in the younger vs. elderly groups (P>0.05 for all). One-year all-cause mortality was similar in the younger and elderly groups (0% vs. 3.2%, respectively; P>0.05).
PTPA can be performed safely and effectively, even in elderly patients, and could be considered as an alternative therapeutic strategy for elderly patients who are too fragile for pulmonary endarterectomy (PEA) or who are treated in institutions without highly experienced PEA surgeons.
经皮腔内肺动脉成形术（PTPA）是一种最近开发的用于慢性血栓栓塞性肺动脉高压（CTEPH）的基于导管的治疗方法。本研究的目的是探讨PTPA治疗老年CTEPH患者的安全性和有效性。
共分析了70例患者（中位年龄63岁）的257次PTPA治疗。根据年龄将患者分为两组：（i）较年轻组（<65岁；n = 39）；（ii）老年组（≥65岁；n = 31）。
较年轻组和老年组的血流动力学改善情况相当（肺血管阻力分别下降63.1%和68.2%；P>0.05）。两组每次治疗后在重症监护病房的中位住院时间（分别为1.0天和1.0天）以及每次治疗的住院时间（分别为9.2天和9.4天）相似（所有P>0.05）。再灌注性肺水肿的发生率（所有治疗中分别为23.4%和26.3%）以及其他并发症，如造影剂肾病（分别为0%和2.0%）、感染（分别为0%和0%）和神经并发症（分别为0%和1.0%），在较年轻组和老年组中相当（所有P>0.05）。较年轻组和老年组的1年全因死亡率相似（分别为0%和3.2%；P>0.05）。
即使是老年患者，PTPA也能安全有效地进行，对于因身体过于虚弱而无法进行肺动脉内膜剥脱术（PEA）或在没有经验丰富的PEA外科医生的机构接受治疗的老年患者，PTPA可被视为一种替代治疗策略。
