Preoperative Partitioning of Pulmonary Vascular Resistance Correlates With Early Outcome After Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension
Why the study?
Does preoperative pulmonary arterial occlusion pressure waveform analysis predict postoperative hemodynamics and outcomes in patients with CTEPH undergoing PTE?
Population
26 patients with chronic thromboembolic pulmonary hypertension undergoing preoperative right heart…
Design
Cohort
Follow-up
early postoperative
Authors
Discussion
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Implication
Rup <60% was associated with all postoperative deaths after PTE; leaves open whether occlusion waveform analysis should guide CTEPH surgical decisions.
Key Points
- Determine whether preoperative pulmonary vascular resistance partitioning using arterial occlusion pressure waveform analysis can identify distal small-vessel disease and predict outcomes following pulmonary thromboendarterectomy.
- Assessed 26 patients with chronic thromboembolic pulmonary hypertension who underwent preoperative right heart catheterization before pulmonary thromboendarterectomy.
- Acquired pulmonary artery occlusion pressure waveforms in triplicate to derive preoperative partitioning of pulmonary vascular resistance, focusing on upstream resistance.
- Compared preoperative resistance partitions with early postoperative hemodynamics and in-hospital mortality.
- Preoperative upstream resistance correlated significantly with postoperative total pulmonary resistance index (R² = 0.79, P < 0.001) and postoperative mean pulmonary artery pressure (R² = 0.75, P < 0.001).
- All 4 postoperative deaths occurred in patients who presented with a preoperative upstream resistance below 60%.
Structured PICO
Does preoperative pulmonary arterial occlusion pressure waveform analysis predict postoperative hemodynamics and outcomes in patients with CTEPH undergoing PTE?
P
Population
26 patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing preoperative right heart catheterization before pulmonary thromboendarterectomy (PTE)
I
Intervention
Preoperative pulmonary arterial occlusion pressure waveform analysis to assess upstream resistance (Rup)
O
Outcome
Correlation of preoperative upstream resistance (Rup) with postoperative total pulmonary resistance index and mean pulmonary artery pressuresurrogate
Preoperative pulmonary arterial occlusion pressure waveform analysis can identify CTEPH patients at high risk for persistent pulmonary hypertension and poor outcomes after pulmonary thromboendarterectomy.
Cite This Study
Kim et al. (2003) studied this question.