Martin-Suarez Sofia, Gliozzi Gregorio, Cavalli Giulio Giovanni, Orioli Valentina, Loforte Antonio, Pastore Saverio, Rossi Barbara, Zardin Davide, Galiè Nazzareno, Palazzini Massimiliano, Dardi Fabio, Saia Francesco, Niro Fabio, Pacini Davide
Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S. Orsola Hospital IRCCS, Bologna University, 40138 Bologna, Italy.
Cardiac Anaesthesia Unit, Cardio Thoracic and Vascular Department, S. Orsola Hospital IRCCS, Bologna University, 40138 Bologna, Italy.
J Clin Med. 2022 Jul 27;11(15):4353. doi: 10.3390/jcm11154353.
Background: Pulmonary endarterectomy (PEA) is the gold standard therapy for chronic thromboembolic pulmonary hypertension (CTEPH). Traditionally, pulmonary vascular resistance (PVR) represents the main prognostic factor after surgery. The pulmonary artery pulsatility index (PAPi) has been proposed for the assessment of RV in advanced heart failure, but it has never been applied in CTEPH patients. The aim of the present study is to describe PAPi in patients who underwent PEA, before and after surgery, and to define its predictive impact on postoperative outcomes. Methods: We retrospectively reviewed 188 consecutive adult patients who underwent PEA, between December 2003 and December 2021. PAPi was calculated for 186 patients and reported. Patients were partitioned in two groups using median preoperative PAPi as cutoff value: Group 1 with PAPi ≤ 8.6 (n = 94) and Group 2 with PAPi > 8.6 (n = 92). The propensity-score-matched analysis identified 67 pairs: Early outcomes were compared between two groups. Results: Mean preoperative PAPi was 10.3 ± 7.2. Considering matched populations, no differences emerged in terms of postoperative hemodynamics; Group 1 demonstrated higher 90-day mortality significance (10.4% vs. 3.0%, p = 0.082); the need for mechanical circulatory support (MCS) was similar, but successful weaning was unlikely (25% vs. 85.7%, p = 0.032). Conclusions: Mean PAPi in the CTEPH population is higher than in other diseases. Low PAPi (≤8.6) seems to be associated with lower postoperative survival and successful weaning from MCS.
肺动脉内膜剥脱术（PEA）是慢性血栓栓塞性肺动脉高压（CTEPH）的金标准治疗方法。传统上，肺血管阻力（PVR）是术后主要的预后因素。肺动脉搏动指数（PAPi）已被用于评估晚期心力衰竭患者的右心室功能，但从未应用于CTEPH患者。本研究的目的是描述接受PEA手术患者术前和术后的PAPi，并确定其对术后结局的预测影响。方法：我们回顾性分析了2003年12月至2021年12月期间连续接受PEA手术的188例成年患者。计算并报告了186例患者的PAPi。以术前PAPi中位数作为截断值，将患者分为两组：第1组PAPi≤8.6（n = 94），第2组PAPi>8.6（n = 92）。倾向评分匹配分析确定了67对：比较两组的早期结局。结果：术前平均PAPi为10.3±7.2。考虑匹配人群，术后血流动力学方面无差异；第1组90天死亡率更高（10.4%对3.0%，p = 0.082）；机械循环支持（MCS）的需求相似，但成功撤机的可能性不大（25%对85.7%，p = 0.032）。结论：CTEPH患者的平均PAPi高于其他疾病。低PAPi（≤8.6）似乎与较低的术后生存率和MCS成功撤机有关。
