Abstract

FAVALORO, Roberto R et al. Tromboendarterectomia pulmonar: tratamiento de elección para la hipertensión pulmonar tromboembólica crónica 18 años de seguimiento del Hospital Universitario Fundación Favaloro. Rev. amer. med. respiratoria [online]. 2011, vol.11, n.2, pp.74-83. ISSN 1852-236X.

Pulmonary thromboendarterectomy is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension. Objective: To report our 18-years experience in pulmonary thromboendarterectomy. Material and Methods: Forty one patients were analyzed between November/1992 and August/2010. Inclusion criteria: mean pulmonary artery pressure (PAPm) >30 mmHg and pulmonary vascular resistance (PVR) >300 dinas/sec.cm-5. Pulmonary angiography determined the surgical feasibility. Survival was calculated using the Kaplan-Meier method and to compare the 2 groups log rank test. Results: Forty four percent of the patients were classified in class IV. The hemodynamic changes after pulmonary thromboendarterectomy were significant (p < 0.001). PAPm 53 ± 2 vs. 29 ± 2 mm Hg, PVR 857 ± 65 vs. 245 ± 25 dinas/sec. cm-5 and CI 2.3 ± 0.1 vs. 3 ± 0.1. In-hospital mortality was 15%; in classes II - III was 4%, and in class IV 33% (p = 0.01). Late mortality was 12%. Ninety three percent of the patients improved their functional class. Overall survival at 1, 2, 5 and 10 years was 85%, 82%, 75% and 71% respectively. Survival according to functional class showed significant differences (p = 0.02). Conclusion: In our experience pulmonary thromboendarterectomy showed benefits even in this high risk population.

Keywords : Pulmonary Hypertension; Pulmonary thromboendarterectomy; Pulmonary thromboembolism; Chronic thromboembolic pulmonary hypertension; Right ventricle.

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