肺血栓内膜切除术后残留肺动脉高压的多模式疗法

IF 0.3 Q4 SURGERY
María Jesús López-Gude , Lorena Coronel , Teresa Velazquez-Martín , Enrique Pérez-de la Sota , Jorge E. Centeno-Rodríguez , Andrea Eixerés-Esteve , Eva Aguilar-Blanco , Juan Meca-Aguirrezabalaga , Pilar Escribano-Subías , Christian Muñoz-Guijosa
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引用次数: 0

摘要

肺血栓动脉内膜切除术是治疗慢性血栓栓塞性肺动脉高压的首选方法。对于不能手术或术后残留肺动脉高压的患者,应考虑药物治疗或肺动脉成形术干预。目的交流手术系列的最新结果。描述肺动脉高压持续存在的长期演变。材料和方法截至2023年12月,我们已完成405例手术。301例患者6个月时行右心导管。结果住院死亡率为4.5%。在161例(53%)对照插管中,平均肺动脉压小于或等于25 mmHg。这些患者在3年、5年和10年的累积生存率分别为99%、99%和97%。78例(26%)血压在26 - 34 mmHg之间。30%的患者需要肺血管扩张剂治疗,3%的患者需要肺血管成形术。3年、5年和10年的累积生存率分别为100%、95%和95%。其余患者血压均大于等于35 mmHg。82%用肺血管扩张剂治疗,21%用肺血管成形术治疗。3年、5年和10年的累积生存率分别为92%、90%和81%,与前3组比较差异有统计学意义(Log Rank = 0.02)。结论肺内膜切除术对绝大多数患者是有效的。在复杂的情况下,如术后残余肺动脉高压,多学科方法和多模式治疗是必不可少的,可以获得良好的长期效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tratamiento multimodal en la hipertensión pulmonar residual tras tromboendarterectomía pulmonar
Pulmonary thromboendarterectomy surgery is the treatment of choice in chronic thromboembolic pulmonary hypertension. Medical treatment or intervention through pulmonary angioplasty should be considered in inoperable patients or with residual pulmonary hypertension after surgery.

Objectives

Communicate the current results of the surgical series. Describe the long-term evolution based on the persistence of pulmonary hypertension.

Material and methods

Until December 2023 we have performed 405 procedures. Right heart catheterization was obtained in 301 patients at 6 months.

Results

Hospital mortality was 4.5%. In 161 control catheterizations (53%), the mean pulmonary artery pressure was less or equal than 25 mmHg. The cumulative survival in these patients is 99%, 99% and 97% at 3, 5 and 10 years. In 78 cases (26%) the pressure was between 26 and 34 mmHg. 30% have needed treatment with pulmonary vasodilators and 3% have required pulmonary angioplasty. The cumulative survival is 100%, 95% and 95% at 3, 5 and 10 years. In the rest, the pressure was equal or greater than 35 mmHg. 82% have been treated with pulmonary vasodilators and 21% with pulmonary angioplasties. The cumulative survival is 92%, 90% and 81% at 3, 5 and 10 years with significant difference with the previous groups (Log Rank = 0.02).

Conclusions

Pulmonary endarterectomy surgery is curative in the majority of patients. The multidisciplinary approach and multimodal treatment are essential in complex situations such as residual pulmonary hypertension after surgery, achieving excellent long-term results.
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来源期刊
CiteScore
0.50
自引率
66.70%
发文量
109
审稿时长
69 days
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