This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200801-101OCv1 178/4/419    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Corsico, A. G. Articles by Viganò, M. PubMed PubMed Citation Articles by Corsico, A. G. Articles by Viganò, M.

Long-term Outcome after Pulmonary Endarterectomy

¹ Division of Respiratory Diseases, ² Division of Cardiac Surgery, and ³ Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

Correspondence and requests for reprints should be addressed to Isa Cerveri, M.D., Clinica di Malattie dell'Apparato Respiratorio, Fondazione IRCCS Policlinico San Matteo, via Taramelli 5, 27100 Pavia, Italy. E-mail: icerveri{at}smatteo.pv.it

Rationale: There are few follow-up studies on long-term cardiopulmonary function after pulmonary endarterectomy (PEA), the operation of choice for chronic thromboembolic pulmonary hypertension (CTEPH).

Objectives: To prospectively evaluate long-term outcome of patients with CTEPH treated with PEA.

Methods: Between 1994 and 2006, 157 patients (mean age 55 yr) were treated with PEA at Pavia University Hospital. The patients were evaluated before PEA and at 3 months (n = 132), 1 year (n = 110), 2 years (n = 86), 3 years (n = 69), and 4 years (n = 49) afterward by NYHA class, right heart hemodynamic, spirometry, carbon monoxide transfer factor (TL_CO), arterial blood gas, and treadmill incremental exercise test.

Measurements and Main Results: Cumulative survival was 84%. Within 3 months, 18 patients died in-hospital and 2 had lung transplantation; during long-term follow-up, 6 died, 1 had lung transplantation, and 3 had a second PEA (2.5 events per 100 person-years). NYHA class III–IV was the most important predictor of late death, lung transplant, or PEA redo (hazard ratio, 3.94). Extraordinary improvement in NYHA class, hemodynamic, and Pa_O2 were achieved in the first 3 months (P < 0.001) and persisted during follow-up; exercise tolerance progressively increased over time (P < 0.001). At 4 years, although 74% of the patients were in NYHA class I and none was in class IV, 24% had pulmonary vascular resistance greater than 500 dyne.s/cm⁵ or Pa_O2 less than 60 mm Hg; they were significantly older and were more frequently in NYHA class III–IV 3 months after surgery than the others.

Conclusions: After PEA, long-term survival and cardiopulmonary function recovery is excellent in most patients.

Key Words: chronic thromboembolic pulmonary hypertension • surgery • survival • lung function • hemodynamic

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject There is substantial agreement on short-term favorable outcome after pulmonary endarterectomy, but there are few follow-up studies on long-term cardiopulmonary function after the operation. What This Study Adds to the Field This study provides evidence that long-term survival after pulmonary endarterectomy is excellent and cardiopulmonary function can be almost normalized in most patients.