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Balloon pulmonary angioplasty followed by pulmonary endarterectomy: Combination treatment for high-surgical-risk patients with chronic thromboembolic pulmonary hypertension
OBJECTIVES: Our goal was to evaluate the combined effects of balloon pulmonary angioplasty (BPA) followed by pulmonary endarterectomy (PEA) to treat high-surgical-risk patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: This study included 58 patients with CTEPH who had pul...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9985147/ https://www.ncbi.nlm.nih.gov/pubmed/36825847 http://dx.doi.org/10.1093/icvts/ivad031 |
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author | Shimahara, Yusuke Suzuki, Shun Fujiyoshi, Toshiki Honda, Sayaka Koizumi, Nobusato Yamashita, Jun Sasaki, Yuichi Ito, Ryosuke Takahashi, Lisa Nakai, Michikazu Ogino, Hitoshi |
author_facet | Shimahara, Yusuke Suzuki, Shun Fujiyoshi, Toshiki Honda, Sayaka Koizumi, Nobusato Yamashita, Jun Sasaki, Yuichi Ito, Ryosuke Takahashi, Lisa Nakai, Michikazu Ogino, Hitoshi |
author_sort | Shimahara, Yusuke |
collection | PubMed |
description | OBJECTIVES: Our goal was to evaluate the combined effects of balloon pulmonary angioplasty (BPA) followed by pulmonary endarterectomy (PEA) to treat high-surgical-risk patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: This study included 58 patients with CTEPH who had pulmonary vascular resistance of ≥1000 dyn·s/cm(5), mean pulmonary arterial pressure (mPAP) of ≥45 mmHg or mPAP of 38–44 mmHg with comorbidities. Of these, 21 patients underwent the combined therapy of BPA followed by PEA (BPA group) and 37 underwent direct PEA (non-BPA group). Preoperative and postoperative results were compared between the 2 groups. An early postoperative composite event comprised the postoperative use of extracorporeal membrane oxygenation or intra-aortic balloon pump, in-hospital death, rescue BPA, prolonged ventilation, tracheostomy, prolonged stay in the intensive care unit, deep sternal wound infection and cerebral infarction. RESULTS: Before the first intervention (before BPA or direct PEA), patients in the BPA group had a higher mPAP than those in the non-BPA group. After undergoing BPA before PEA, the BPA group demonstrated significantly decreased mPAP and pulmonary vascular resistance (43 vs 52 mmHg, P < 0.001; 636 vs 965 dyn·s/cm(5), P = 0.003, respectively) and significantly increased cardiac output (4.1 vs 3.5 l/min, P = 0.041). Notably, the number of patients with the early postoperative composite event was significantly lower in the BPA group than in the non-BPA group (4.8% vs 35.1%, P = 0.011). CONCLUSIONS: Compared with direct PEA, the combination therapy of BPA followed by PEA can be a feasible and effective risk-reduction strategy for high-surgical-risk patients with CTEPH. |
format | Online Article Text |
id | pubmed-9985147 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-99851472023-03-05 Balloon pulmonary angioplasty followed by pulmonary endarterectomy: Combination treatment for high-surgical-risk patients with chronic thromboembolic pulmonary hypertension Shimahara, Yusuke Suzuki, Shun Fujiyoshi, Toshiki Honda, Sayaka Koizumi, Nobusato Yamashita, Jun Sasaki, Yuichi Ito, Ryosuke Takahashi, Lisa Nakai, Michikazu Ogino, Hitoshi Interdiscip Cardiovasc Thorac Surg Vascular Disease OBJECTIVES: Our goal was to evaluate the combined effects of balloon pulmonary angioplasty (BPA) followed by pulmonary endarterectomy (PEA) to treat high-surgical-risk patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: This study included 58 patients with CTEPH who had pulmonary vascular resistance of ≥1000 dyn·s/cm(5), mean pulmonary arterial pressure (mPAP) of ≥45 mmHg or mPAP of 38–44 mmHg with comorbidities. Of these, 21 patients underwent the combined therapy of BPA followed by PEA (BPA group) and 37 underwent direct PEA (non-BPA group). Preoperative and postoperative results were compared between the 2 groups. An early postoperative composite event comprised the postoperative use of extracorporeal membrane oxygenation or intra-aortic balloon pump, in-hospital death, rescue BPA, prolonged ventilation, tracheostomy, prolonged stay in the intensive care unit, deep sternal wound infection and cerebral infarction. RESULTS: Before the first intervention (before BPA or direct PEA), patients in the BPA group had a higher mPAP than those in the non-BPA group. After undergoing BPA before PEA, the BPA group demonstrated significantly decreased mPAP and pulmonary vascular resistance (43 vs 52 mmHg, P < 0.001; 636 vs 965 dyn·s/cm(5), P = 0.003, respectively) and significantly increased cardiac output (4.1 vs 3.5 l/min, P = 0.041). Notably, the number of patients with the early postoperative composite event was significantly lower in the BPA group than in the non-BPA group (4.8% vs 35.1%, P = 0.011). CONCLUSIONS: Compared with direct PEA, the combination therapy of BPA followed by PEA can be a feasible and effective risk-reduction strategy for high-surgical-risk patients with CTEPH. Oxford University Press 2023-02-24 /pmc/articles/PMC9985147/ /pubmed/36825847 http://dx.doi.org/10.1093/icvts/ivad031 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Vascular Disease Shimahara, Yusuke Suzuki, Shun Fujiyoshi, Toshiki Honda, Sayaka Koizumi, Nobusato Yamashita, Jun Sasaki, Yuichi Ito, Ryosuke Takahashi, Lisa Nakai, Michikazu Ogino, Hitoshi Balloon pulmonary angioplasty followed by pulmonary endarterectomy: Combination treatment for high-surgical-risk patients with chronic thromboembolic pulmonary hypertension |
title | Balloon pulmonary angioplasty followed by pulmonary endarterectomy: Combination treatment for high-surgical-risk patients with chronic thromboembolic pulmonary hypertension |
title_full | Balloon pulmonary angioplasty followed by pulmonary endarterectomy: Combination treatment for high-surgical-risk patients with chronic thromboembolic pulmonary hypertension |
title_fullStr | Balloon pulmonary angioplasty followed by pulmonary endarterectomy: Combination treatment for high-surgical-risk patients with chronic thromboembolic pulmonary hypertension |
title_full_unstemmed | Balloon pulmonary angioplasty followed by pulmonary endarterectomy: Combination treatment for high-surgical-risk patients with chronic thromboembolic pulmonary hypertension |
title_short | Balloon pulmonary angioplasty followed by pulmonary endarterectomy: Combination treatment for high-surgical-risk patients with chronic thromboembolic pulmonary hypertension |
title_sort | balloon pulmonary angioplasty followed by pulmonary endarterectomy: combination treatment for high-surgical-risk patients with chronic thromboembolic pulmonary hypertension |
topic | Vascular Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9985147/ https://www.ncbi.nlm.nih.gov/pubmed/36825847 http://dx.doi.org/10.1093/icvts/ivad031 |
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