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Pulmonary endarterectomy in CTEPH: clinical and hemodynamic long term effect
Session:
Painel 9 - Doença Valvular 9
Speaker:
Pedro Silvério António
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Pedro Silvério António; Rui Plácido; Tatiana Guimarães; Inês Aguiar Ricardo; Joana Rigueira; Tiago Graça Rodrigues; Rafael Santos; Nelson P. Cunha; Afonso Nunes Ferreira; Sara Couto Pereira; Pedro Morais; Joana Brito; Beatriz Silva; Pedro Alves Da Silva; Ana Mineiro; Paulo Campos; Ana G. Almeida; Fausto José Pinto
Abstract
<p><strong>Introduction</strong></p> <p>Pulmonary endarterectomy (PEA) is currently the standard approach for chronic thromboembolic pulmonary hypertension (CTEPH). Although a potential curative effect has been reported, the clinical and hemodynamic long-term effects of PEA remain under investigation.</p> <p><strong>Objective:</strong> We sought to evaluate the clinical, analytical and hemodynamic impact of patients (pts) submitted to PEA due to CTEPH.</p> <p><strong>Methods:</strong></p> <p>This was an observational single center study of established diagnose of CTEPH pts undergoing PEA between January 2016 and February 2019. Demographic, clinical, analytic laboratorial and hemodynamic data were collected, and results were obtained using Willcoxon test.</p> <p><strong>Results:</strong></p> <p>24 patients were assigned for PEA (mean age 59.7±12.9 years; 54.2% female, basal weight : 80.3±17.3Kg). Congenital thrombophilia was diagnosed in 20.8% of pts and 12.5% had criteria of antiphospholipid syndrome. On the preoperative evaluation, pts presented: 6-min walk test of 312.2 ±90.9m and 37.5% pts required continuous long term O2 oxygen therapy (mean 3.7L/min). 87,5% pts were already under treatment with specific vasodilating pulmonary vasodilators therapy (n=21), presenting a median WHO functional class of 2 On right heart catheterization (RHC) pts fulfilled criteria of pre-capillary PH with a mean PAPm of 51.0±11.6, mean PCWP of 13.4±3.7 and mean PVR of 11.5±4.7.</p> <p>After PEA, pts were evaluated with a mean follow-up of 5.6±6.4 months. 45.8% had persistent PH, however a significant improvement was detected on RHC parameters: PAPm: 49 (42-59) vs 26 (21.3-46,3), p=0.001; PVR: 11.0 (7.3-15.1) vs 4.2 (2.5-6.2), p=0.001; cardiac output: 3.6 (3.2-4.2) vs 5.01 (3.8-5.4), p=0.031; SvO: 57.5 (51.5-61) vs 66.5 (59-70.5), p=0.001. In addition, pts presented significant improvement on the median WHO functional class (3,0 (2-3) vs 1,0 (1-2), p<0.001) and 6-min walk test: 312 (245-370) vs 360 (300-460), p=0.047.</p> <p><strong>Conclusion:</strong></p> <p>In this carefully selected cohort of chronic thromboembolic disease patients, pulmonary endarterectomy resulted in significant improvement in symptoms and hemodynamic parameters. This is in light with current state of art, reinforcing the indication of surgical intervention in patients with CTEPH.</p>
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