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The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension
Pulmonary endarterectomy (PEA) is the gold standard treatment for operable chronic thromboembolic pulmonary hypertension (CTEPH). However, a proportion of patients with operable disease decline surgery. There are currently no published data on this patient group. The aim of this study was to identif...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Respiratory Society
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340636/ https://www.ncbi.nlm.nih.gov/pubmed/30002102 http://dx.doi.org/10.1183/13993003.00589-2018 |
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author | Quadery, Syed Rehan Swift, Andrew J. Billings, Catherine G. Thompson, Alfred A.R. Elliot, Charles A. Hurdman, Judith Charalampopoulos, Athanasios Sabroe, Ian Armstrong, Iain J. Hamilton, Neil Sephton, Paul Garrad, Sian Pepke-Zaba, Joanna Jenkins, David P. Screaton, Nicholas Rothman, Alexander M. Lawrie, Allan Cleveland, Trevor Thomas, Steven Rajaram, Smitha Hill, Catherine Davies, Christine Johns, Christopher S. Wild, Jim M. Condliffe, Robin Kiely, David G. |
author_facet | Quadery, Syed Rehan Swift, Andrew J. Billings, Catherine G. Thompson, Alfred A.R. Elliot, Charles A. Hurdman, Judith Charalampopoulos, Athanasios Sabroe, Ian Armstrong, Iain J. Hamilton, Neil Sephton, Paul Garrad, Sian Pepke-Zaba, Joanna Jenkins, David P. Screaton, Nicholas Rothman, Alexander M. Lawrie, Allan Cleveland, Trevor Thomas, Steven Rajaram, Smitha Hill, Catherine Davies, Christine Johns, Christopher S. Wild, Jim M. Condliffe, Robin Kiely, David G. |
author_sort | Quadery, Syed Rehan |
collection | PubMed |
description | Pulmonary endarterectomy (PEA) is the gold standard treatment for operable chronic thromboembolic pulmonary hypertension (CTEPH). However, a proportion of patients with operable disease decline surgery. There are currently no published data on this patient group. The aim of this study was to identify outcomes and prognostic factors in a large cohort of consecutive patients with CTEPH. Data were collected for consecutive, treatment-naive CTEPH patients at the Pulmonary Vascular Disease Unit of the Royal Hallamshire Hospital (Sheffield, UK) between 2001 and 2014. Of 550 CTEPH patients (mean±sd age 63±15 years, follow-up 4±3 years), 49% underwent surgery, 32% had technically operable disease and did not undergo surgery (including patient choice n=72 and unfit for surgery n=63), and 19% had inoperable disease due to disease distribution. The 5-year survival was superior in patients undergoing PEA (83%) versus technically operable disease who did not undergo surgery (53%) and inoperable due to disease distribution (59%) (p<0.001). Survival was superior in patients following PEA compared with those offered but declining surgery (55%) (p<0.001). In patients offered PEA, independent prognostic factors included mixed venous oxygen saturation, gas transfer and patient decision to proceed to surgery. Outcomes in CTEPH following PEA are excellent and superior to patients declining surgery, and strongly favour consideration of a surgical intervention in eligible patients. |
format | Online Article Text |
id | pubmed-6340636 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-63406362019-01-24 The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension Quadery, Syed Rehan Swift, Andrew J. Billings, Catherine G. Thompson, Alfred A.R. Elliot, Charles A. Hurdman, Judith Charalampopoulos, Athanasios Sabroe, Ian Armstrong, Iain J. Hamilton, Neil Sephton, Paul Garrad, Sian Pepke-Zaba, Joanna Jenkins, David P. Screaton, Nicholas Rothman, Alexander M. Lawrie, Allan Cleveland, Trevor Thomas, Steven Rajaram, Smitha Hill, Catherine Davies, Christine Johns, Christopher S. Wild, Jim M. Condliffe, Robin Kiely, David G. Eur Respir J Original Articles Pulmonary endarterectomy (PEA) is the gold standard treatment for operable chronic thromboembolic pulmonary hypertension (CTEPH). However, a proportion of patients with operable disease decline surgery. There are currently no published data on this patient group. The aim of this study was to identify outcomes and prognostic factors in a large cohort of consecutive patients with CTEPH. Data were collected for consecutive, treatment-naive CTEPH patients at the Pulmonary Vascular Disease Unit of the Royal Hallamshire Hospital (Sheffield, UK) between 2001 and 2014. Of 550 CTEPH patients (mean±sd age 63±15 years, follow-up 4±3 years), 49% underwent surgery, 32% had technically operable disease and did not undergo surgery (including patient choice n=72 and unfit for surgery n=63), and 19% had inoperable disease due to disease distribution. The 5-year survival was superior in patients undergoing PEA (83%) versus technically operable disease who did not undergo surgery (53%) and inoperable due to disease distribution (59%) (p<0.001). Survival was superior in patients following PEA compared with those offered but declining surgery (55%) (p<0.001). In patients offered PEA, independent prognostic factors included mixed venous oxygen saturation, gas transfer and patient decision to proceed to surgery. Outcomes in CTEPH following PEA are excellent and superior to patients declining surgery, and strongly favour consideration of a surgical intervention in eligible patients. European Respiratory Society 2018-09-16 /pmc/articles/PMC6340636/ /pubmed/30002102 http://dx.doi.org/10.1183/13993003.00589-2018 Text en Copyright ©ERS 2018 http://creativecommons.org/licenses/by-nc/4.0/ This article is open access and distributed under the terms of the Creative Commons Attribution Licence 4.0. |
spellingShingle | Original Articles Quadery, Syed Rehan Swift, Andrew J. Billings, Catherine G. Thompson, Alfred A.R. Elliot, Charles A. Hurdman, Judith Charalampopoulos, Athanasios Sabroe, Ian Armstrong, Iain J. Hamilton, Neil Sephton, Paul Garrad, Sian Pepke-Zaba, Joanna Jenkins, David P. Screaton, Nicholas Rothman, Alexander M. Lawrie, Allan Cleveland, Trevor Thomas, Steven Rajaram, Smitha Hill, Catherine Davies, Christine Johns, Christopher S. Wild, Jim M. Condliffe, Robin Kiely, David G. The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension |
title | The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension |
title_full | The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension |
title_fullStr | The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension |
title_full_unstemmed | The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension |
title_short | The impact of patient choice on survival in chronic thromboembolic pulmonary hypertension |
title_sort | impact of patient choice on survival in chronic thromboembolic pulmonary hypertension |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340636/ https://www.ncbi.nlm.nih.gov/pubmed/30002102 http://dx.doi.org/10.1183/13993003.00589-2018 |
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