Does pulmonary thromboendarterectomy without deep hypothermic circulatory arrest improve hemodynamics and clinical outcomes in patients with chronic thromboembolic pulmonary hypertension?
Pulmonary thromboendarterectomy without deep hypothermic circulatory arrest is feasible and significantly improves hemodynamics and symptoms in patients with type I and II CTEPH.
Introduction: For the treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) thromboendarterectomy (PTE) is increasingly performing with deep hypothermic circulatory arrest (DHCA). At the last time, there are some publications with describing of the PTE performance without DHCA. Objective: To analyze and evaluate the results of surgical treatment of CTEPH under cardiopulmonary bypass (CPB), cardioplegia and without DHCA. Methods: Retrospective analysis of the PTE results in 70 patients operated on from January 2018 to February 2023 was conducted. Evaluation pre- and postoperative clinical examinations and invasive pulmonary artery pressure (PAP) measurement in all patients involved were systematically analyzed. Results: The average age of the patients was 48.1 ± 10.5 years, including 44.3 % males and 55.7 % females. Due to New York Heart Association (NYHA), 6 (8.6%) patients preoperatively belonged to class II, 48 (68.6%) to class III and 16 (22.9%) to class IV. The thrombotic masses structure according to Jamieson’s classification belonged to type I in 42 (60%) patients and to type II in 28 (40%) patients. Postoperatively the systolic PAP (PAPs, mmHg) decreased from 80.8 ± 22.9 to 40.8 ± 13.5, the mean pressure (mPAP, mmHg)—from 48.5 ± 14.4 to 25.3 ± 7.3, respectively. Four patients died. The in-hospital mortality rate was 5.7%. According to NYHA, the clinical conditions have also improved: class I was observed in 48 (73%) patients, class II in 15 (23%) and class III in 3 (4%) patients. The postoperative transthoracic echocardiogram (TEE) revealed an improvement of the right ventricle (RV) function and computed tomography (CT) angiogram demonstrated a positive dynamic and a surgery adequacy. Conclusion: PTE under CPB without DHCA can lead to immediate positive results with significant improvements in hemodynamic parameters and life quality without typical DHCA complications in patients with thrombi type I and II according to Jamieson’s classification.
Gorbachevsky et al. (Wed,) studied this question.