Abstract
Introduction. Pulmonary thromboendarterectomy (PEA) is the primary treatment for most patients with chronic thromboembolic pulmonary hypertension (CTEPH). Purpose: to present the results of PEA and postoperative management of patients with CTEPH operated in our center.
Material and methods. Prospective analysis of surgical treatment of 71 patients treated from 2013 to 2021 (general group) performed. Comparison of perioperative outcomes of the early (represented by patients operated from 2014 to 2017 (n=34)) and late (represented by patients operated from 2018 to 2021 (n=37)) groups.
Results. The average age of the patients was 48.1±10.5 years, the ratio of men and women was 52.1% / 47.9%. Causes contributing to the development of CTEPH: thrombophlebitis of the veins of the lower extremities – 83.1%; coagulopathy (thrombophilia) – 5.6%; the presence of an endocardial stimulator – 2.8%; antiphospholipid syndrome – 2.8%; drug addiction – 1.4%; malignant tumor of pulmonary artery (LA) – 1.4%; unknown cause – 2.8%. Within one year, the decrease in pulmonary artery pressure was 30% of the baseline, the right atrium pressure decreased by 45%, and the pulmonary vascular resistance decreased by 50%. The growth of cardiac index amounted to 30%. The initial hemodynamic profile did not differ significantly in the early and late groups. Performing PEA contributed to a significant improvement in SpO2 in all patients. In all groups, there was a significant decrease in the level of NT-proBNP. In most patients, NYHA functional class progressed from III/IV to I/II. Perioperative complications occurred in 50,7% of patients: hospital mortality was 12.7% (in the early group – 20.6%; in the late group – 5.4% (p=0.05)); one-year survival was 84.5% (in the early group – 76.5%; in the late group – 91.9%; p=0.07); three-year survival – 80.3% (70.6% vs 89.2%; p<0.05).
Conclusion. Performing PEA helps to reduce the severity of clinical symptoms of the disease, improve hemodynamic parameters, increase exercise tolerance and increase patient survival. When comparing the results of the operation in the early and late groups, their improvement towards the late period was established.
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About the authors
- Sergey V. Gorbachevsky, Dr. Med. Sci., Professor, Chief Researcher; ORCID
- Komoliddin Kh. Rakhmonov, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
- Ruslan A. Aybazov, Junior Researcher; ORCID
- Karen V. Petrosyan, Dr. Med. Sci., Head of Department; ORCID
- Leo A. Bockeria, Academician of Russian Academy of Sciences, President of Center; ORCID
