Abstract
Operational risk is not only an indicator that determines the likelihood of a successful outcome of surgical treatment, but also an important prognostic factor that plays a key role during the postoperative period and affects the quality of the patient's later life. Patients with a long-term presence of chronic thromboembolic pulmonary hypertension (CTEPH) are a cohort of difficult patients, both in terms of supervision and in terms of the choice of treatment methods. A staged approach with the use of pulmonary artery thromboendarterectomy as the first stage of surgical treatment, and transluminal balloon angioplasty of the pulmonary artery as the second stage in combination with medical support is the most effective and relatively safe treatment tactic in patients with CTEPH with an extremely high operational risk, allowing a significant improve the prognosis and quality of life of this group of patients.
References
- Ikeda N. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Cardiovasc. Interv. Ther. 2020; 35 (2): 130–41. DOI: 10.1007/s12928-019-00637-2
- Simonneau G., Gatzoulis M.A., Adatia I., Celermajer D., Denton C., Ghofrani A. et al. Updated clinical classifcation of pulmonary hypertension. J. Am. Coll. Cardiol. 2013; 62 (25 Suppl): D34–41.
- Mahmud E., Madani M.M., Kim N.H., Poch D., Ang L., Behnamfar O. et al. Chronic thromboembolic pulmonary hypertension: evolving therapeutic approaches for operable and inoperable disease. J. Am. Coll. Cardiol. 2018; 71: 2468–86.
- Martí D., Gómez V., Escobar C., Wagner C., Zamarro C., Sánchez D. et al. Incidence of symptomatic and asymptomatic chronic thromboembolic pulmonary hypertension. Arch. Bronconeumol. 2010; 46 (12): 628–33.
- Klok F.A., van Kralingen K.W., van Dijk A.P., Heyning F.H., Vliegen H.W., Huisman M.V. Prospective cardiopulmonary screening program to detect chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism. Haematologica. 2010; 95 (6): 970–5. 6. Hoole S.P., Jenkins D.P. Chronic thromboembolic pulmonary hypertension: interventional approaches. Heart. 2020; 106 (19): 1525–31. DOI: 10.1136/heartjnl-2019-316291
- Jenkins D., Madani M., Fadel E., D'Armini A.M., Mayer E. Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension. Eur. Respir. Rev. 2017; 26: 160111. DOI: 10.1183/16000617.0111-2016
- Jaff M.R., McMurtry M.S., Archer S.L., Cushman M., Goldenberg N., Goldhaber S.Z. et al; American Heart Association Council on cardiopulmonary, critical care, perioperative and resuscitation; American Heart Association Council on peripheral vascular disease; American Heart Association Council on arteriosclerosis, thrombosis and vascular biology. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011; 123 (16): 1788–830. DOI: 10.1161/CIR.0b013e318214914f
- Gall H., Hoeper M.M., Richter M.J., Cacheris W., Hinzmann B., Mayer E. An epidemiological analysis of the burden of chronic thromboembolic pulmonary hypertension in the USA, Europe and Japan. Eur. Respir. Rev. 2017; 26 (143): 160121. DOI: 10.1183/16000617.0121-2016
- Горбачевский С.В., Петросян К.В., Рахмонов К.Х., Хальвани М.Ю., Хачатурова И.Ю., Сабитов А.А. Первый опыт двухэтапной хирургической коррекции хронической тромбоэмболической легочной гипертензии у больных с крайне высоким операционным риском. Грудная и сердечно-сосудистая хирургия. 2020; 62 (5): 447–54. DOI: 10.24022/0236- 2791-2020-62-5-447-454
- Mullin Ch.J., Klinger J.R. Chronic thromboembolic pulmonary hypertension. Heart Fail. Clinics. 2018; 14 (3): 339–51. DOI: 10.1016/j.hfc.2018.02.009
- Petrosyan K.V., Gorbachevskiy S.V., Jeblawi I.A., Sobolev A.V., Dadabaev G.M. Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension patients with high surgical risk (four years experience). Russian Journal of Thoracic and Cardiovascular Surgery. 2020; 62 (4): 334–44 (in Russ.). DOI: 10.24022/0236- 2791-2020-62-4-334-344
- Berman M., Gopalan D., Sharples L., Screaton N., Maccan C., Sheares K. et al. Right ventricular reverse remodeling after pulmonary endarterectomy: magnetic resonance imaging and clinical and right heart catheterization assessment. Pulm. Circ. 2014; 4 (1): 36–44. DOI: 10.1086/674884
- Mayer E., Jenkins D., Lindner J., D'Armini A.M., Kloek J., Meyns B. et al. Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. J. Thorac. Cardiovasc. Surg. 2011; 141: 702–10. DOI: 10.1016/j.jtcvs.2010.11.024
- Wasserman K., Hansen J.E., Sue D.Y., Stringer W.W., Whipp B.J. Principles of exercise testing and interpretation: including pathophysiology and clinical applications. Fifth edition. Philadelphia: Lippincott Williams & Wilkins; 2012. 16. American Thoracic Society; American College of Chest Physicians. ATS/ACCP Statement on cardiopulmonary exercise testing. Am. J. Respir. Crit. Care Med. 2003; 167 (2): 211–77. DOI: 10.1164/rccm.167.2.211
- Guazzi M., Adams V., Conraads V., Halle M., Mezzani A., Vanhees L. et al. European Association for Cardiovascular Prevention & Rehabilitation; American Heart Association. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012; 126 (18): 2261–74. DOI: 10.1161/CIR.0b013e31826fb946
- Bokeriya L.A., Bokeriya O.L., Glushko L.A., Mironenko M.Yu., Donakanyan S.A., Biniashvili M.B. et al. Long-term results of state acessment of cardiorespiratory system in patients with chronic ischemic heart disease after incomplete myocardial revascularization. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2019; 20 (7–8): 602–9 (in Russ.). DOI: 10.24022/1810- 0694-2019-20-7-8-602-609
- Glushko L.A., Shmalts A.A. Assessment of the state of the cardiorespiratory system in pulmonary hypertension associated with congenital heart disease. Creative Cardiology. 2021; 15 (2): 167–79 (in Russ.). DOI: 10.24022/1997-3187-2021-15-2-167-179
About the authors
- Sergey V. Gorbachevskiy, Dr. Med. Sci., Professor, Head of department of surgical treatment of heart diseases with progressive pulmonary hypertension; ORCID
- Komollidin Kh. Rakhmonov, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
- Lyudmila A. Glushko, Cand. Med. Sci., Chief of Pulmonary Tests and Gas Exchange Monitoring Group – Functional diagnostician, Cardiologist, Associate Professor; ORCID
- Gulamzhan M. Dadabaev, Cand. Med. Sci., Researcher; ORCID
- Amirillo A. Sabitov, Cardiovascular Surgeon; ORCID
