Leung Wai Sang Stephane, Morin Jean-Francois, Hirsch Andrew
Division of Cardiac Surgery, Jewish General Hospital, Montreal, Quebec, Canada.
Division of Respirology, Jewish General Hospital, Montreal, Quebec, Canada.
J Card Surg. 2016 Jan;31(1):3-8. doi: 10.1111/jocs.12646. Epub 2015 Nov 4.
To evaluate the midterm hemodynamic and functional outcome of pulmonary endarterectomy (PEA) for patients with advanced chronic thromboembolic pulmonary hypertension (CTEPH).
Thirty-eight consecutive patients underwent PEA for CTEPH from May 2004 to March 2012. All patients were followed prospectively at six months postoperatively and annually thereafter. Each patient underwent serial cardiopulmonary exercise testing (CPET) and transthoracic echocardiography, and were followed for up to four years.
Overall, 31.5% (12/38) of patients had Jamieson class II disease while 65.8% (25/38) had class III disease. There were three in-hospital mortalities (7.9%), all of which had baseline pulmonary vasculature resistance (PVR) greater than 1400 dynes-sec-cm(-5) . Preoperative PVR and mean pulmonary artery pressure were 1209 ± 723 dynes-sec-cm(-5) and 50 ± 14 mmHg, respectively, signifying a high-risk operative group. Ninety-seven percent of patients were in NYHA class III or IV preoperatively. At median follow-up of 29 months 89.5% (17/19) of patients were in NYHA class I or II. CPET revealed a progressive increase in peak oxygen consumption from 16.5 ± 4.1 ml/kg/min at first follow-up, to a plateau of 20.2 ± 5.6 ml/kg/min (p = 0.032) at two years.
CPET can be used to quantify progress in functional capacity post-CTEPH, although improvements in peak oxygen consumption plateau at two years.
评估晚期慢性血栓栓塞性肺动脉高压（CTEPH）患者接受肺动脉内膜剥脱术（PEA）的中期血流动力学和功能结局。
2004年5月至2012年3月，38例连续的CTEPH患者接受了PEA。所有患者在术后6个月进行前瞻性随访，此后每年随访一次。每位患者均接受了系列心肺运动试验（CPET）和经胸超声心动图检查，并随访了长达4年。
总体而言，31.5%（12/38）的患者患有Jamieson II级疾病，而65.8%（25/38）的患者患有III级疾病。有3例院内死亡（7.9%），所有死亡患者的基线肺血管阻力（PVR）均大于1400达因-秒-厘米⁻⁵ 。术前PVR和平均肺动脉压分别为1209±723达因-秒-厘米⁻⁵ 和50±14 mmHg，表明这是一个高风险手术组。97%的患者术前为纽约心脏协会（NYHA）III级或IV级。在中位随访29个月时，89.5%（17/19）的患者为NYHA I级或II级。CPET显示，从首次随访时的峰值耗氧量16.5±4.1 ml/kg/min逐渐增加，到两年时达到20.2±5.6 ml/kg/min的平台期（p = 0.032）。
CPET可用于量化CTEPH后功能能力的进展，尽管峰值耗氧量在两年时达到平台期。
