Boehm Panja M, Schwarz Stefan, Thanner Jürgen, Veraar Cecilia, Gerges Mario, Gerges Christian, Lang Irene, Apfaltrer Paul, Prosch Helmut, Taghavi Shahrokh, Klepetko Walter, Ankersmit Hendrik Jan, Moser Bernhard
Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria.
JTCVS Open. 2022 Feb 23;10:62-72. doi: 10.1016/j.xjon.2022.02.018. eCollection 2022 Jun.
The ratio of pulmonary artery (PA) and ascending aorta (AA) diameters has recently been shown to be a useful indicator for disease severity and predictor of outcome in patients with pulmonary hypertension and heart failure. This study aimed at evaluating the applicability of this ratio for perioperative risk assessment of patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy.
In this retrospective cohort study on 149 patients undergoing pulmonary endarterectomy between 2013 and 2020, the preoperative PA to AA ratio was analyzed on axial computed tomography. Variables of pulmonary hemodynamic status were assessed during preoperative right heart catheterization and postoperative Swan-Ganz catheter measurements. Perioperative survival was analyzed by Kaplan-Meier method and log-rank tests.
Preoperative computed tomography measurements showed a median AA diameter of 31 mm (range, 19-47 mm), and a median PA diameter of 36 mm (range, 25-55 mm). The calculated median PA to AA ratio was 1.13 (range, 0.79-1.80). PA to AA ratio correlated positively with PA pressure (systolic, = 0.352 [ < .001]; diastolic, = 0.406 [ < .001]; mean, = 0.318 [ < .001]) and inversely with age ( = -0.484 [ < .001]). Univariable Cox regression analysis identified PA diameter ( = .008) as a preoperative parameter predictive of survival. There was a significant difference (log-rank = .037) in 30-day survival probability for patients with lower PA to AA ratios (<1.136; survival probability, 97.4%) compared with patients with higher ratios (>1.136; survival probability, 88.9%).
PA to AA ratio shows a correlation with other variables associated with pulmonary hypertension. In addition, patients with higher PA to AA ratios have lower survival probabilities after PEA. Further analysis of PA to AA ratio on the selection of chronic thromboembolic pulmonary hypertension for different treatment modalities-pulmonary endarterectomy, medical therapy, and or balloon pulmonary angioplasty-is warranted.
肺动脉（PA）与升主动脉（AA）直径之比最近已被证明是评估肺动脉高压和心力衰竭患者疾病严重程度及预后的有用指标。本研究旨在评估该比值在接受肺动脉内膜剥脱术的慢性血栓栓塞性肺动脉高压患者围手术期风险评估中的适用性。
在这项对2013年至2020年间149例行肺动脉内膜剥脱术患者的回顾性队列研究中，通过轴向计算机断层扫描分析术前PA与AA的比值。在术前右心导管检查和术后Swan-Ganz导管测量期间评估肺血流动力学状态变量。采用Kaplan-Meier法和对数秩检验分析围手术期生存率。
术前计算机断层扫描测量显示，AA直径中位数为31mm（范围19 - 47mm），PA直径中位数为36mm（范围25 - 55mm）。计算得出的PA与AA比值中位数为1.13（范围0.79 - 1.80）。PA与AA比值与PA压力呈正相关（收缩压，r = 0.352 [P <.001]；舒张压，r = 0.406 [P <.001]；平均压，r = 0.318 [P <.001]），与年龄呈负相关（r = -0.484 [P <.001]）。单变量Cox回归分析确定PA直径（P =.008）为预测生存的术前参数。PA与AA比值较低（<1.136；生存概率97.4%）的患者与比值较高（>1.136；生存概率88.9%）的患者相比，30天生存概率存在显著差异（对数秩P =.037）。
PA与AA比值与其他肺动脉高压相关变量存在相关性。此外，PA与AA比值较高的患者在肺动脉内膜剥脱术后生存概率较低。有必要进一步分析PA与AA比值，以用于慢性血栓栓塞性肺动脉高压患者不同治疗方式（肺动脉内膜剥脱术、药物治疗和/或球囊肺动脉成形术）的选择。
