Abstract 17195: Improved Surgical Outcomes of Distal Type Cteph
Introduction: Pulmonary endarterectomy (PEA) is a potentially curative treatment of CTEPH. Nevertheless, nearly a half of patients were deemed inoperable mainly due to inaccessible disease. With increased surgical experience, we have applied PEA to distal type CTEPH, and sought to determine surgical outcomes of patients with distal type CTEPH in the last 5 years compared with those treated in the previous period.
Methods: Among 244 patients who were diagnosed for CTEPH in our hospital between 1995 and 2015, 144 patients were diagnosed as distal disease. The extent of central disease was quantitated by adding up the number of abnormal central artery up to maximum score of 4 and distal disease was defined as the score of ≤1. In the previous period, 30 of 111 patients (27%) with distal disease underwent PEA (group 1). In the recent period, 20 of 33 patients (61%) with distal disease and additional 7 patients who were deemed inoperable due to distal disease in the previous period underwent PEA (group 2).
Results: Patients in group 2 were significantly older (53±10 vs 63±10 years old, p=0.001, group 1 vs 2, respectively). Preoperative mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) were comparable between both groups (mPAP: 48±10 vs 46±9 mmHg, p=0.44, and PVR: 828±333 vs 771±321 dyn.s.cm-5, p=0.51, group 1 vs 2, respectively). In-hospital mortality was significantly decreased from 7 patients (23%) in group 1 to 1 patient (3.7%) in group 2 (p=0.02). Residual pulmonary hypertension was mainly attributed to the mortality. Postoperative mPAP and PVR of survivors were significantly decreased with no differences between both groups (mPAP: 29±9 vs 26±9 mmHg, p=0.36 and PVR: 401±271 vs 325±178 dyn.s.cm-5, p=0.25). Despite preoperative diagnosis of distal type CTEPH, surgical specimens showed that most patients had central disease defined by Jamieson classification type I or II (group 1: 86% and group 2: 78%).
Conclusion: With increased surgical experience, outcomes of patients with distal disease undergoing PEA have improved. Preoperative diagnosis of distal disease may not be definitive, and most patients with distal disease have central disease and can benefit from PEA.
Author Disclosures: K. Ishida: None. M. Masada: None. G. Matsumiya: None.
- © 2016 by American Heart Association, Inc.