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The actuarial survival analysis of the surgical and non-surgical therapy regimen for chronic thromboembolic pulmonary hypertension

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Abstract

Aim To characterize the in-hospital mortality and the actuarial survival of surgical and non-surgical therapy regimen in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Methods A retrospective cohort study was conducted in 504 patients with CTEPH, who were treated surgically (n = 360), or non-surgically (n = 144) in Anzhen Hospital from February 1989 to August 2007. The patients in surgical group received a standard pulmonary thromboendarterectomy (PTE), while those in non-surgical group were given thrombolytic therapy. The actuarial survival of the two groups was determined with the Kaplan–Meier survival curves. Univariate analysis and multivariate binary logistic regression and Cox proportional hazard analysis were used to identify the risk factors for the in-hospital and late deaths. Results The in-hospital mortality for the surgical group and non-surgical group were 4.44% and 3.50%, respectively. For the proximal type of CTEPH, the actuarial survival at 10 and 15 years of the surgical group and non-surgical group were 94.60 ± 2.38%, 90.96 ± 4.24% and 81.4 ± 7.14%, 56.43 ± 14.7%, respectively (χ2 = 12.33, P = 0.0004). For the distal type of CTEPH, the actuarial survival at 10 and 15 years of the surgical group and non-surgical group were 71.78 ± 4.66%, 29.57 ± 15.1% and 69.84 ± 7.78%, 32.59 ± 13.7%, respectively (χ2 = 0.03, P = 0.874). Conclusion The PTE procedure has statistically superiority over thrombolytic therapy for the proximal type of CTEPH in terms of actuarial survival; however, for the distal type of CTEPH, the PTE procedure provides no benefits with regard to actuarial survival.

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Abbreviations

CTEPH:

Chronic thromboembolic pulmonary hypertension

PTE:

Pulmonary thromboendarterectomy

DHCA:

Deep hypothermia circulatory arrest

PVR:

Pulmonary vascular resistance

CTA:

Computer tomography angiography

References

  1. Condliffe R, Kiely DG, Gibbs JS et al (2008) Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med 177:1122–1127

    Article  PubMed  Google Scholar 

  2. Van Beek EJ, Kuijer PM, Buller HR et al (1997) The clinical course of the patients with suspected pulmonary embolism. Arch Intern Med 157:2593–2598

    Article  PubMed  Google Scholar 

  3. Jamieson SW, Kapelanski DP (2000) Pulmonary endarterectomy. Curr Probl Surg 26:167–252

    Google Scholar 

  4. Archibald CJ, Auger WR, Fedullo PF et al (1999) Long term outcome after pulmonary thromboendarterctomy. Am J Respir Crit Care Med 160:523–528

    CAS  PubMed  Google Scholar 

  5. Corsico AG, Darmini AM, Cerveri I et al (2008) Long-term outcome after pulmonary endarterectomy. Am J Respir Crit Care Med 178:419–424

    Article  PubMed  Google Scholar 

  6. Yoshimi S, Tanabe N, Masuda M et al (2008) Survival and quality of life for patients with distal type chronic thromboembolic pulmonary hypertension. Circ J 72:958–965

    Article  PubMed  Google Scholar 

  7. Suntharalingam J, Machado RD, Sharples LD et al (2007) Demographic features, BMPR2 status and outcomes in distal chronic thromboembolic pulmonary hypertension. Thorax 62:617–622

    Article  PubMed  Google Scholar 

  8. Thistlethwaite PA, Lee SH, Du L, Wolf PL et al (2001) Human angiopoietin gene expression is a marker for severity ofpulmonary hypertension in patients undergoing pulmonary thromboendarterectomy. J Thorac Cardiovasc Surg 122:65–73

    Article  CAS  PubMed  Google Scholar 

  9. Pietra GG, Edward WD, Kay JM et al (1989) Histopathology of primary pulmonary hypertension. A qualitative andquantitative study of pulmonary blood vessels from 58 patients in the National heart, lung, and blood institute, primary pulmonary hypertension registry. Circulation 80:1198–1206

    CAS  PubMed  Google Scholar 

  10. Carbrol S, Souza R, Jais X (2007) Intravenous epoprostenol in inoperable chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant 26:357–362

    Article  Google Scholar 

  11. Nagaya N, Sasaki N, Ando M et al (2003) Prostacyclin therapy before pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension. Chest 123:338–343

    Article  CAS  PubMed  Google Scholar 

  12. Bresser P, Fedullo PF, Auger WR et al (2004) Continuous intravenous epoprostenol for chronic thromboembolic pulmonary hypertension. Eur Respir J 23:595–600

    Article  CAS  PubMed  Google Scholar 

  13. Ulrich S, Speich R, Domenighetti G et al (2007) Bosentan therapy for chronic thromboembolic pulmonary hypertension. A national open label study assessing the effect of Bosentan on haemodynamics, exercise capacity, quality of life, safety and tolerability in patients with chronic thromboembolic pulmonary hypertension (BOCTEPH-Study). Swiss Med Wkly 137:573–580

    CAS  PubMed  Google Scholar 

  14. Bresser P, Pepke-Zaba J, Jais X et al (2006) Medical therapies for chronic thromboembolic pulmonary hypertension: an evolving treatment paradigm. Proc Am Thorac Soc 3:594–600

    Article  PubMed  Google Scholar 

  15. Suntharalingam J, Treacy CM, Doughty NJ et al (2008) Long-term use of sildenafil in inoperable chronic thromboembolic pulmonary hypertension. Chest 134:229–236

    Article  CAS  PubMed  Google Scholar 

  16. Huges RJ, Jais X, Bonderman D et al (2006) The efficacy of bosentan in inoperable chronic thromboembolic pulmonary hypertension: a 1-year follow-up study. Eur Respir J 28:138–143

    Article  Google Scholar 

  17. Romaszkiewicz R, Lewczuk J, Piszko P et al (2006) Results of one-year anticoagulation in patients with newly detected chronic thromboembolic pulmonary hypertension not treated with pulmonary endarterectomy. Kardiol Pol 64:1196–1202

    PubMed  Google Scholar 

  18. Kim NHS (2006) Assessment of operability in chronic thromboembilic pulmonary hypertersion. Proc Am Thorac Soc 3:584–588

    Article  PubMed  Google Scholar 

  19. Piszko P, Lewczuk J, Lenartowska L et al (2007) Pulmonary thromboembolism in 102 consecutive patients with chronic atrial fibrillation. Diagnostic value of echocardiography. Kardiol Pol 65:246–251

    PubMed  Google Scholar 

  20. Raisinghani A, Ben-Yehuda O (2006) Echocardiography in chronic thromboembolic pulmonary hypertension. Semin Thorac Cardiovasc Surg 18:230–235

    Article  PubMed  Google Scholar 

  21. Hardziyenka M, Reesink HJ et al (2007) A novel echocardiographic predictor of in-hospital mortality and mid-term haemodynamic improvement after pulmonary endarterectomy for chronic thrombo-embolic pulmonary hypertension. Eur Heart J 28:842–849

    Article  PubMed  Google Scholar 

  22. Naeije R, Huez S (2007) Reflections on wave reflections in chronic thromboembolic pulmonary hypertension. Eur Heart J 28:785–787

    Article  PubMed  Google Scholar 

  23. Bonderman D, Skoro-Sajer N, Jakowitsch J et al (2007) Predictors of outcome in chronic thromboembolic pulmonary hypertension. Circulation 115:2153–2158

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University (BAZH–CMU), Beijing Institute of Heart, Lung and Vessel Disease, Beijing, 100029, China

    Hui-Li Gan, Jian-Qun Zhang, Ping Bo, Qi-Wen Zhou & Sheng-Xun Wang

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  1. Hui-Li Gan
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  2. Jian-Qun Zhang
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  3. Ping Bo
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  5. Sheng-Xun Wang
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Correspondence to Hui-Li Gan.

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Ethical approval: The Ethics Committee approved this retrospective study and waived the need to obtain patient consent for the study. Written informed consent was obtained from each patient for the operation.

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Gan, HL., Zhang, JQ., Bo, P. et al. The actuarial survival analysis of the surgical and non-surgical therapy regimen for chronic thromboembolic pulmonary hypertension. J Thromb Thrombolysis 29, 25–31 (2010). https://doi.org/10.1007/s11239-009-0319-1

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  • DOI: https://doi.org/10.1007/s11239-009-0319-1

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