Hobohm Lukas, Keller Karsten, Münzel Thomas, Konstantinides Stavros V, Lankeit Mareike
Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany.
Department of Cardiology, University Medical Center Mainz, Mainz, Germany.
Pulm Circ. 2021 Apr 28;11(2):20458940211008069. doi: 10.1177/20458940211008069. eCollection 2021 Apr-Jun.
Chronic thromboembolic pulmonary hypertension is considered as a rare but severe complication after acute pulmonary embolism and is potentially curable by pulmonary endarterectomy. We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension patients and to investigate predictors of the in-hospital course. We analyzed data on the characteristics, comorbidities, treatments, and in-hospital outcomes for all chronic thromboembolic pulmonary hypertension patients treated with pulmonary endarterectomy in the German nationwide inpatient sample between 2006 and 2016. Overall, 1398 inpatients were included. Annual number of pulmonary endarterectomy increased from 67 in 2006 to 194 in 2016 ( < 0.001), in parallel with a significant decrease of in-hospital mortality (10.9% in 2008 to 1.5% in 2016; < 0.001). Patients' characteristics shifted slightly toward older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Independent predictors of in-hospital mortality were age (OR 1.03 (95%CI: 1.01-1.05); = 0.001), right heart failure (2.55 (1.37-4.76); = 0.003), in-hospital complications such as ischemic stroke (6.87 (1.06-44.70); = 0.044) and bleeding events like hemopneumothorax (24.93 (6.18-100.57); < 0.001). Annual pulmonary endarterectomy volumes per center below 10 annual procedures were associated with higher rates of adverse in-hospital outcomes. Annual numbers of chronic thromboembolic pulmonary hypertension patients treated with pulmonary endarterectomy increased markedly in Germany between 2006 and 2016, in parallel with a decrease of in-hospital mortality. Our findings suggest that perioperative management of pulmonary endarterectomy, institutional experience, and patient selection is crucial and has improved over time.
慢性血栓栓塞性肺动脉高压被认为是急性肺栓塞后一种罕见但严重的并发症，可通过肺动脉内膜剥脱术治愈。我们旨在评估11年间慢性血栓栓塞性肺动脉高压患者肺动脉内膜剥脱术的院内结局的时间趋势，并调查院内病程的预测因素。我们分析了2006年至2016年德国全国住院患者样本中所有接受肺动脉内膜剥脱术治疗的慢性血栓栓塞性肺动脉高压患者的特征、合并症、治疗方法及院内结局的数据。总体而言，共纳入1398例住院患者。肺动脉内膜剥脱术的年度手术例数从2006年的67例增加至2016年的194例（<0.001），与此同时，院内死亡率显著下降（从2008年的10.9%降至2016年的1.5%；<0.001）。随着时间推移，患者特征略有变化，年龄更大、慢性肾功能不全和肥胖的患病率更高，而住院时间则随时间减少。院内死亡的独立预测因素为年龄（比值比1.03（95%置信区间：1.01 - 1.05）；P = 0.00）、右心衰竭（2.55（1.37 - 4.76）；P = 0.003）、缺血性卒中等院内并发症（6.87（1.06 - 44.70）；P = 0.044）以及血气胸等出血事件（24.93（6.18 - 100.57）；<0.001）。每个中心每年肺动脉内膜剥脱术手术例数低于10例与更高的院内不良结局发生率相关。2006年至2016年期间，德国接受肺动脉内膜剥脱术治疗的慢性血栓栓塞性肺动脉高压患者的年度例数显著增加，与此同时院内死亡率下降。我们的研究结果表明，肺动脉内膜剥脱术的围手术期管理、机构经验和患者选择至关重要，并且随着时间推移已有所改善。
