Long-Term Results after Pulmonary Endarterectomy: a Single Center's 20 Years Experiences in China and its Pathological Result

Sheng Liu, Jiade Zhu, Yunhu Song

Chinese Academy of Medical Science,Fuwai Hospital, Beijing, China

Date, time and location: 2018.05.26 17:00, Press Hall, 2F

Abstract

Object：There is seldom pulmonary endarterectomy(PEA) experiences reported in Asia.We report our center's experiences of up to 20 years for pulmonary endarterectomy procedure.

Method:Retrospectively collected all the datas of 147 cases of chronic thrombo-embolic pulmonary hypertension(CTEPH)patients from 1997 to 2017.06,and a long-term follow-up have been done.

Result:There are 86 and 22 cases of patients ranked NYHA class III and IV before surgery,111 males,36 females.Systolic pulmonary artery pressure(sPAP) decreased from86.78±21.28mmHg to 45.92±19.12mmHg(p<0.001),mean pulmonary artery pressure (mPAP) decreased from 51.65±13.36mmHg to 27.66±12.39mmHg(p<0.001) before and after surgery,peri-operative motality rate=6.12%,and there is no deaths in the recent 70 cases of PEA.Another 6 patients died during follow-up period(1-241 months,median follow-up lengthy:18 months),cumulative survival rate=89.8%.Multi-variant analysis indicate the pulmonary vascular resistance(PVR) is the only factor influence the peri-operative mortality,cox multi-variant risk analysis indicate that a pathological diagnose of pulmonary artery sarcoma(OR=33.24,p=0.024) and the post-operation PVR(OR=1.004,p=0.004) ,diastolic pulmonary artery pressure(dPAP,OR=1.20,p=0.020) can influence the long-term survival for CTEPH patients.Pathological result:47.56% of patients have been found fresh embolism formed in the paraffin pathological result,6.09% of patients have been diagnosed with pulmonary artery sarcoma and 1 patient was diagnosed with chondrosarcoma.There is no obvious difference between prosimal and distal obstruction teams in terms of paraffin pathological result and other factors,females are more inclined to develop into distal CTEPH(p<0.05).

Conclusion:PEA can bring a satisfying hemodynamic improvement for patients with CTEPH,the mortality rate is significantly decreased with a accumulated management experiences.Patients with higher PVR before surgery have a higher mortality rate during peri-operative period,the result of post-operation dPAP and PVR can influence the late deaths for CTEPH,patients with pulmonary artery sarcoma have a 32.24 times higher mortality rate in the long time period compared with pure embolism team.Female are more inclined to develop to distal CTEPH which can be a limitation to surgery.