Long-term outcomes of surgery for chronic thromboembolic pulmonary hypertension compared with medical therapy at a single Korean center
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Background/Aims: Pulmonary endarterectomy (PEA) is the gold standard for treating chronic thromboembolic pulmonary hypertension (CTEPH) in Western countries. The aim of this study was to investigate the long-term outcomes of performing PEA on CTEPH patients in comparison with medical therapy at a single Korean center. Methods: This retrospective study included 88 CTEPH patients. These patients were classified into the PEA group (n = 37) or non-PEA group (i.e., medical therapy; n = 51). The clinical characteristics, hemodynamic data, and long-term survival rates were compared. Independent prognostic factors for CTEPH were also investigated. Results: CTEPH was not associated with either gender, and the mean age at diagnosis was 53.3 ± 13.7 years. Echocardiography revealed that the mean peak velocity of the tricuspid regurgitation jet was 4.2 ± 0.7 m/sec and the mean pulmonary arterial pressure was 51.7 ± 15.1 mmHg. The PEA and non-PEA groups demonstrated no significant differences, except in terms of the right ventricular end-diastolic diameter. The survival rates of the PEA group were significantly higher than the non-PEA group at 1, 3, 5, and 10 years (p = 0.032). Multivariate analyses indicated that World Health Organization class IV and PEA were significant predictors of poorer and better outcomes, respectively. Conclusions: PEA demonstrates more favorable effects on long-term survival than medical therapy in Korean CTEPH patients who were considered operable.
Abstract
Background/Aims: Pulmonary endarterectomy (PEA) is the gold standard for treating chronic thromboembolic pulmonary hypertension (CTEPH) in Western countries. The aim of this study was to investigate the long-term outcomes of performing PEA on CTEPH patients in comparison with medical therapy at a single Korean center. Methods: This retrospective study included 88 CTEPH patients. These patients were classified into the PEA group (n = 37) or non-PEA group (i.e., medical therapy; n = 51). The clinical characteristics, hemodynamic data, and long-term survival rates were compared. Independent prognostic factors for CTEPH were also investigated. Results: CTEPH was not associated with either gender, and the mean age at diagnosis was 53.3 ± 13.7 years. Echocardiography revealed that the mean peak velocity of the tricuspid regurgitation jet was 4.2 ± 0.7 m/sec and the mean pulmonary arterial pressure was 51.7 ± 15.1 mmHg. The PEA and non-PEA groups demonstrated no significant differences, except in terms of the right ventricular end-diastolic diameter. The survival rates of the PEA group were significantly higher than the non-PEA group at 1, 3, 5, and 10 years (p = 0.032). Multivariate analyses indicated that World Health Organization class IV and PEA were significant predictors of poorer and better outcomes, respectively. Conclusions: PEA demonstrates more favorable effects on long-term survival than medical therapy in Korean CTEPH patients who were considered operable.
참고문헌 (30)
- Lang I., "Chronic thromboembolic pulmonary hypertension:a distinct disease entity", Eur Respir Rev, 24, pp.246~252 (2015)
- Kim NH, "Chronic thromboembolic pulmonary hypertension", J Am Coll Cardiol, 62(25 Suppl), pp.D92~D99 (2013)
- Madani MM, "Pulmonary endarterectomy: recent changes in a single institution’s experience of more than 2,700 patients", Ann Thorac Surg, 94, pp.97~103 (2012)
- Ogino H., "Recent advances of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension including Japanese experiences", Gen Thorac Cardiovasc Surg, 62, pp.9~18 (2014)
- Li YD, "Improvement of right ventricular dysfunction after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: utility of echocardiography to demonstrate restoration of the right ventricle during 2-year follow-up", Thromb Res, 131, pp.e196~e201 (2013)
- Mayer E, "Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry", J Thorac Cardiovasc Surg, 141, pp.702~710 (2011)
- Suntharalingam J, "Longterm use of sildenafil in inoperable chronic thromboembolic pulmonary hypertension", Chest, 134, pp.229~236 (2008)
- Hoeper MM., "Pharmacological therapy for patients with chronic thromboembolic pulmonary hypertension", Eur Respir Rev, 24, pp.272~282 (2015)
- 오세진, "Clinical Outcomes of Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension: 12-Year Experience", The Korean Journal of Thoracic and Cardiovascular Surgery, 46(1), pp.41~48 (2013), 대한흉부외과학회
- 김현국, "만성 혈전색전성 폐고혈압 환자에서 폐동맥 혈전내막제거술의 효과", Tuberculosis and Respiratory Diseases, 59(6), pp.644~650 (2005), 대한결핵및호흡기학회
- 임주영, "만성 폐동맥 색전증의 치료로서 내막제거술의 임상적 결과: 색전증 분류에 따른 접근", The Korean Journal of Thoracic and Cardiovascular Surgery, 41(5), pp.591~597 (2008), 대한흉부외과학회
- Guerin L, "Prevalence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: prevalence of CTEPH after pulmonary embolism", Thromb Haemost, 112, pp.598~605 (2014)
- D’Armini AM., "Diagnostic advances and opportunities in chronic thromboembolic pulmonary hypertension", Eur Respir Rev, 24, pp.253~262 (2015)
- Kang BJ, "Improved survival of Korean patients with idiopathic pulmonary arterial hypertension after the introduction of targeted therapies", Heart Lung, 43, pp.561~568 (2014)
- Chemla D, "New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure", Chest, 126, pp.1313~1317 (2004)
- Condliffe R, "Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension", Am J Respir Crit Care Med, 177, pp.1122~1127 (2008)
- Tiede H, "Global burden of chronic thromboembolic pulmonary hypertension (CTEPH): an epidemiological analysis", Eur Respir J, 44(Suppl 58), pp.P2326~ (2014)
- Choi WI., "Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism: a retrospective analysis in a university teaching hospital", Clin Exp Thromb Hemost, 2, pp.4~7 (2015)
- Jang MJ, "Incidence of pregnancy-associated venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database", J Thromb Haemost, 9, pp.2519~2521 (2011)
- Tapson VF, "Incidence and prevalence of chronic thromboembolic pulmonary hypertension: from acute to chronic pulmonary embolism", Proc Am Thorac Soc, 3, pp.564~567 (2006)
- Pepke-Zaba J, "Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry", Circulation, 124, pp.1973~1981 (2011)
- Nishimura R, "Improved survival in medically treated chronic thromboembolic pulmonary hypertension", Circ J, 77, pp.2110~2117 (2013)
- Kunieda T, "Prognoses of primary pulmonary hypertension and chronic majorvessel thromboembolic pulmonary hypertension determined from cumulative survival curves", Intern Med, 38, pp.543~546 (1999)
- Riedel M, "Longterm follow-up of patients with pulmonary thromboembolism:late prognosis and evolution of hemodynamic and respiratory data", Chest, 81, pp.151~158 (1982)
- Corsico AG, "Long-term outcome after pulmonary endarterectomy", Am J Respir Crit Care Med, 178, pp.419~424 (2008)
- Jenkins D., "Pulmonary endarterectomy: the potentially curative treatment for patients with chronic thromboembolic pulmonary hypertension", Eur Respir Rev, 24, pp.263~271 (2015)
- Kunihara T, "Predictors of postoperative outcome after pulmonary endarterectomy from a 14-year experience with 279 patients", Eur J Cardiothorac Surg, 40, pp.154~161 (2011)
- Galie N, "Sildenafil citrate therapy for pulmonary arterial hypertension", N Engl J Med, 353, pp.2148~2157 (2005)
- Simonneau G, "Riociguat for the treatment of chronic thromboembolic pulmonary hypertension: a long-term extension study (CHEST-2)", Eur Respir J, 45, pp.1293~1302 (2015)
- Papamatheakis DG, "Advances in the management of chronic thromboembolic pulmonary hypertension", Curr Hypertens Rep, 17, pp.582~ (2015)