Wuxi Lung Transplant Center, Department of Thoracic Surgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, 299 Qingyang Road, Wuxi, 214023, Jiangsu, China.
The Taihu Rehabilitation Hospital of Jiangsu Province (The Taihu Sanatorium of Jiangsu Province), Wuxi, Jiangsu, China.
BMC Pulm Med. 2024 Aug 26;24(1):410. doi: 10.1186/s12890-024-03213-4.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension with a low incidence. Despite pulmonary endarterectomy(PEA) being the preferred treatment for CTEPH, for patients who failed medical therapy and who are not suitable candidates for PEA, lung transplantation (LT) is still the only effective treatment for end-stage CTEPH; however, there are currently very few reports on the efficacy of LT for CTEPH.
We retrospectively analyzed the clinical data of seven patients diagnosed with CTEPH between July 2019 and July 2021. The follow-up deadline was March, 2022.
The mean age at admission was 54 ± 12 years. The average value of mean pulmonary artery pressure (mPAP) was 40 ± 5 mmHg. The mean preoperative oxygenation index(PaO2/FiO2) was 203 ± 56 mm Hg. After evaluation, one patient underwent left LT and the rest underwent bilateral LT. Three patients received intraoperative veno-venous extracorporeal membrane oxygenation (ECMO) support, and four patients received intraoperative veno-arterial ECMO support. The average postoperative mPAP was 19 ± 4 mmHg. The mean postoperative oxygenation index(PaO2/FiO2) was 388 ± 83 mmHg. There was a significant difference between the preoperative and postoperative mPAP and oxygenation index(PaO2/FiO2). All patients recovered well and were discharged 37 ± 19 days postoperatively. The mean follow-up duration was 19 ± 8 months. There was no recurrence of CTEPH.
LT is an effective treatment for end-stage CTEPH, which can improve cardiopulmonary function and quality of life and prolong survival. Patients who are unable to tolerate PEA should be considered for LT as early as possible when internal medicine failed.
慢性血栓栓塞性肺动脉高压（CTEPH）是一种发病率较低的肺动脉高压。尽管肺动脉内膜切除术（PEA）是 CTEPH 的首选治疗方法，但对于药物治疗失败且不适合 PEA 的患者，肺移植（LT）仍然是治疗终末期 CTEPH 的唯一有效方法；然而，目前关于 LT 治疗 CTEPH 的疗效报告非常少。
我们回顾性分析了 2019 年 7 月至 2021 年 7 月期间诊断为 CTEPH 的 7 例患者的临床资料。随访截止日期为 2022 年 3 月。
入院时平均年龄为 54±12 岁。平均肺动脉压（mPAP）值为 40±5mmHg。术前平均氧合指数（PaO2/FiO2）为 203±56mmHg。评估后，1 例患者行左 LT，其余患者行双侧 LT。3 例患者术中接受静脉-静脉体外膜肺氧合（ECMO）支持，4 例患者术中接受静脉-动脉 ECMO 支持。术后平均 mPAP 为 19±4mmHg。术后平均氧合指数（PaO2/FiO2）为 388±83mmHg。术前与术后 mPAP 和氧合指数（PaO2/FiO2）差异有统计学意义。所有患者均恢复良好，术后 37±19 天出院。平均随访时间为 19±8 个月。无 CTEPH 复发。
LT 是治疗终末期 CTEPH 的有效方法，可改善心肺功能和生活质量，延长生存时间。对于内科治疗无效的患者，应尽早考虑 LT。
