Early outcomes after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in the era of epoprostenol sodium

Yusuke Sakurai; Yoshiyuki Takami; Akihiro Kobayashi; Tsutomu Yanagisawa; Kentaro Amano; Yoshiro Higuchi; Masato Tochii; Michiko Ishida; Toshimitsu Satou; Hiroshi Ishikawa; Masayoshi Kobayashi; Koji Hattori; Motomi Ando; Yasushi Takagi

doi:10.20407/fmj.3.3_62

Original Articles

Early outcomes after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in the era of epoprostenol sodium

Yusuke Sakurai, Yoshiyuki Takami, Akihiro Kobayashi, Tsutomu Yanagisawa, Kentaro Amano, Yoshiro Higuchi, Masato Tochii, Michiko Ishida, Toshimitsu Satou, Hiroshi Ishikawa, Masayoshi Kobayashi, Koji Hattori, Motomi Ando, Yasushi Takagi

Author information

Yusuke Sakurai
Department of Cardiovascular Surgery, Fujita Health University School of Medicine
Yoshiyuki Takami
Fujita Health University School of Health Sciences
Akihiro Kobayashi
Department of Cardiovascular Surgery, Fujita Health University School of Medicine
Tsutomu Yanagisawa
Department of Cardiovascular Surgery, Fujita Health University School of Medicine
Kentaro Amano
Department of Cardiovascular Surgery, Fujita Health University School of Medicine
Yoshiro Higuchi
Department of Cardiovascular Surgery, Fujita Health University School of Medicine
Masato Tochii
Department of Cardiovascular Surgery, Fujita Health University School of Medicine
Michiko Ishida
Department of Cardiovascular Surgery, Fujita Health University School of Medicine
Toshimitsu Satou
Department of Cardiovascular Surgery, Fujita Health University School of Medicine
Hiroshi Ishikawa
Department of Cardiovascular Surgery, Fujita Health University School of Medicine
Masayoshi Kobayashi
Department of Cardiovascular Surgery, Fujita Health University School of Medicine
Koji Hattori
Department of Cardiovascular Surgery, Fujita Health University School of Medicine
Motomi Ando
Department of Cardiovascular Surgery, Daiyukai Hospital
Yasushi Takagi
Department of Cardiovascular Surgery, Fujita Health University School of Medicine

Keywords: Chronic thromboembolic pulmonary hypertension, Pulmonary endarterectomy, Pulmonary vasodilator

JOURNAL OPEN ACCESS FULL-TEXT HTML

2017 Volume 3 Issue 3 Pages 62-66

DOI https://doi.org/10.20407/fmj.3.3_62

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Abstract

Objectives: Pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is technically demanding. We reviewed the surgical outcomes of consecutive patients who underwent PEA with aggressive use of pulmonary vasodilators, including epoprostenol sodium.

Methods: We retrospectively assessed perioperative clinical data of 122 patients with CTEPH who underwent PEA with hypothermic circulatory arrest between 2005 and 2013. Peri-operatively, all of the patients received pulmonary vasodilator therapy, including epoprostenol sodium and beraprost sodium.

Results: Patients were classified as having CTEPH type 1 (n=57), type 2 (n=32), and type 3 (n=33) disease according to the Jamison classification system. In-hospital mortality was 7.4% (n=9), caused by right heart failure (n=5), pulmonary hemorrhage (n=3), and pneumonia (n=1). The 113 patients who survived PEA showed significantly decreased mPAP (46±11 to 23±10 mmHg, P<0.01) and PVR (826±357 to 237±153 dyne·s^–1·cm^–5, P<0.01).

Conclusions: Aggressive pulmonary vasodilator treatment during surgical PEA results in favorable early outcomes. This treatment also leads to immediate and substantial improvement in pulmonary hemodynamics in patients with CTEPH.

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