Why the study?
Persistent pulmonary hypertension after pulmonary endarterectomy is a major determinant of poor outcome in chronic thromboembolic pulmonary hypertension, and the role of acute vasoreactivity in predicting this is unclear.
Does acute pulmonary vasoreactivity testing with inhaled nitric oxide predict postoperative outcomes in patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy?
Cohort (n=103)
Does acute pulmonary vasoreactivity testing with inhaled nitric oxide predict postoperative outcomes in patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy?
Answers are grounded in this paper and cite their sources.
Acute pulmonary vasoreactivity testing with inhaled nitric oxide identifies patients with CTEPH who are likely to have better long-term survival and freedom from lung transplantation after pulmonary endarterectomy.
BACKGROUND: Surgical pulmonary endarterectomy is the preferred treatment for chronic thromboembolic pulmonary hypertension. Persistent pulmonary hypertension after pulmonary endarterectomy has been recognized as a major determinant of poor outcome. We tested whether acute vasoreactivity identifies chronic thromboembolic pulmonary hypertension patients prone to develop persistent/recurrent pulmonary hypertension after pulmonary endarterectomy and whether the degree of acute vasoreactivity affects survival or freedom from lung transplantation. METHODS AND RESULTS: Right-sided heart catheterization at baseline and after inhalation of 40 ppm nitric oxide for 20 minutes was performed in 103 patients (56.3+/-15.3 years old, 53 women). Reductions in mean pulmonary arterial pressure (DeltamPAP; -8.8+/-12.6%; P<0.0001) and pulmonary vascular resistance (-16.1+/-18.1%; P<0.0001) and an increase in mixed venous saturation during inhaled nitric oxide (9.1+/-11.6%; P<0.0001) were observed. Sixty-two patients underwent pulmonary endarterectomy after a median of 49 days (25th and 75th percentiles: 24 and 123 days). Operated patients were followed up for a median of 70.9 months (25th and 75th percentiles: 14 and 97 months). Change in mPAP during inhaled NO was identified as a predictor of persistent/recurrent pulmonary hypertension after pulmonary endarterectomy. Patients experiencing a reduction in mPAP >10.4% with nitric oxide inhalation had a better postoperative outcome. A significant correlation was found between DeltamPAP and immediate postoperative pulmonary vascular resistance (r=0.5, P<0.0001). CONCLUSIONS: A total of 80 (77.7%) of 103 patients demonstrated acute pulmonary vascular reactivity of some degree. A decrease in mPAP >10.4% under inhaled nitric oxide is a predictor of long-term survival and freedom from lung transplantation in adult patients with chronic thromboembolic pulmonary hypertension who are undergoing pulmonary endarterectomy.
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Skoro‐Sajer et al. (2009) conducted a cohort in Chronic thromboembolic pulmonary hypertension (n=103). Inhaled nitric oxide (acute vasoreactivity testing) vs. Baseline was evaluated on Persistent/recurrent pulmonary hypertension, long-term survival, and freedom from lung transplantation.
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