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Long-term outcomes of combined pulmonary endarterectomy and additional balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

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Abstract

Background

The early and long-term outcomes after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) have been established by several high-volume centers, but the impact of postoperative residual pulmonary hypertension affecting postoperative clinical parameters remains unclear. This study aims to investigate the institutional surgical results of PEA and to evaluate the efficacy of additional balloon pulmonary angioplasty (BPA) for residual pulmonary hypertension.

Patients and methods

We retrospectively reviewed 222 patients (57.7 ± 12.9 years old, 141 female) who underwent PEA for CTEPH at the National Cerebral and Cardiovascular Center between 2000 and 2020.

Results

The preoperative mean pulmonary artery pressure (mPAP) was 45.6 ± 9.7 mmHg and pulmonary vascular resistance (PVR) was 1062 ± 451 dyne*sec/cm−5. Postoperative mPAP (23.4 ± 11 mmHg, 204 patients, P < 0.001) and PVR (419 ± 291 dyne*sec/cm−5, 199 patients, P < 0.001) significantly improved after PEA. Since 2011, 62 patients (28%) underwent BPA after PEA for “catecholamine dependent” residual PH 1 month after PEA in 14, “scheduled” BPA with residual PH 1 year after PEA in 32, and 16 “symptomatic” patients without residual PH. Their mPAP had significantly improved by PEA (48.1 ± 7.7 to 32.0 ± 10.2 mmHg, P < 0.001), and further improved (33.8 ± 11.1 to 26.5 ± 9.1 mmHg, P < 0.001) after BPA.

Conclusions

PEA provided immediate and substantial improvements in pulmonary hemodynamics and favorable long-term survival. In addition, postoperative BPA improved postoperative clinical parameters for eligible patients regardless of the presence of residual PH.

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Date availability

The date that support the findings of this study are available from the corresponding author, Hitoshi Matsuda. The deidentified participant date will not be shared.

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Acknowledgements

Other than the coauthors, 2 surgeons, including Drs Motomi Ando, and Hitoshi Ogino, were involved as operators or conductors of operations during the study period. We would also like to thank enago (www.enago.jp) for English-language editing.

Funding

This article has no funding relevant to its content.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shimmachi, Suita, Osaka, 564-8565, Japan

    Masayuki Nishiyama, Yosuke Inoue, Hiroaki Sasaki, Yoshimasa Seike & Hitoshi Matsuda

  2. Department of Cardiovascular Advanced Medicine in Pulmonary Hypertension, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

    Tatsuo Aoki, Jin Ueda, Akihiro Tsuji & Takeshi Ogo

  3. Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

    Masayuki Nishiyama & Taichi Sakaguchi

Authors
  1. Masayuki Nishiyama
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  2. Yosuke Inoue
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  3. Hiroaki Sasaki
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  4. Yoshimasa Seike
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  5. Tatsuo Aoki
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  6. Jin Ueda
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  7. Akihiro Tsuji
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  8. Takeshi Ogo
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  9. Hitoshi Matsuda
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  10. Taichi Sakaguchi
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Contributions

MN: Conceptualization; Date curation; Formal analysis; Investigation; Methodology; Writing-original draft. YI: Supervision; Validation; Writing-review. HS: Supervision; Validation. YS: Supervision; Validation. TA: Supervision; Validation. JU: Supervision; Validation. AT: Supervision; Validation. TO: Supervision; Validation. HM: Project administration; Investigation; Supervision; Validation; Writing-review& editing. TS: Supervision; Validation.

Corresponding author

Correspondence to Hitoshi Matsuda.

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Conflict of interest

All authors have no conflicts of interests to declare.

IRB information

This study was approved by the institutional review board (M30-065) and was conducted according to the principles of the Declaration of Helsinki. Individual informed consent from each patient was waived given the retrospective study design.

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Nishiyama, M., Inoue, Y., Sasaki, H. et al. Long-term outcomes of combined pulmonary endarterectomy and additional balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Gen Thorac Cardiovasc Surg 71, 291–298 (2023). https://doi.org/10.1007/s11748-022-01872-w

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  • DOI: https://doi.org/10.1007/s11748-022-01872-w

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