The Outcomes of Pulmonary Endarterectomy and Cardiorenal Syndrome

Evgeny Tabakyan, Kirill Mershin , Stanislav Partigulov , Renat Akchurin

National medical research center of cardiology of the Ministry of healthcare of the Russian Federation, Moscow, Russia

Date, time and location: 2018.05.25 10:30, Press Hall, 2F

Abstract

Objective: The aim of the study was to estimate the predictors of outcomes after pulmonary endarterectomy (PEA),) in patients with chronic thromboembolic pulmonary hypertension (CTEPH), to analyze the development of cardiorenal syndrome (CRS).

Methods. PEA with cardiopulmonary bypass (CPB), deep hypothermia, circulatory arrest was performed. Patients with the 2nd -3rd stage of chronic kidney disease (CKD) and acute kidney injury (AKI) after PEA (according to the RIFLE 2004 criteria) were studied. The pulmonary arterial pressure (PAP), cardiac index (СI), pulmonary vascular resistance (PVR) were measured. The inter- and intra-groups differences were analyzed by Mann-Whitney U test and Wilcoxon matched pairs test (p<0.05).

Results. 45 PEA were performed (27 men, 18 women). An overall mortality rate of 11,1%. The causes of in hospital deaths were bronchial bleeding (1), multiorgan failure (1), right heart failure (1), deaths within 30 days of discharge occurred due to haemothorax (1), septical pleural empyema (1). Mean PAP, before and after PEA (p=0,03; p=0,014), maximum CPB lactate level (p=0,04) were higher in cases of death. Seven patients had transient neurological disorders. AKI of 1-3 stages was observed in 12 (27,9%), complete recovery of renal function was noted in 11 cases, renal replacement therapy in one. In patients with CKD (p = 0.031) and AKI (p = 0.014), a longer history of CTEPH was observed. There was decrease of PVR (288 (245; 421) dyne × s × cm-5, and increase of CI (2,3 (2,1;2,5) l/min/m2 (p<0,00001) after PEA in all cohort. Glomerular filtration rate before discharge increased to 107 (91; 116) ml/min (p = 0.00008).

Conclusion. High mean PAP and lactate levels may be predictors of a worse prognosis. A long history of pulmonary hypertension is an adverse factor for CKD and AKI. The positive dynamics of chronic CRS is probably associated with an increase in the СI and renal perfusion.