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
{"title":"肺血栓内膜切除术后残留肺动脉高压的多模式疗法","authors":"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","doi":"10.1016/j.circv.2024.06.003","DOIUrl":null,"url":null,"abstract":"<div><div>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.</div></div><div><h3>Objectives</h3><div>Communicate the current results of the surgical series. Describe the long-term evolution based on the persistence of pulmonary hypertension.</div></div><div><h3>Material and methods</h3><div>Until December 2023 we have performed 405 procedures. Right heart catheterization was obtained in 301 patients at 6<!--> <!-->months.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":42671,"journal":{"name":"Cirugia Cardiovascular","volume":"32 5","pages":"Pages 237-243"},"PeriodicalIF":0.3000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Tratamiento multimodal en la hipertensión pulmonar residual tras tromboendarterectomía pulmonar\",\"authors\":\"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\",\"doi\":\"10.1016/j.circv.2024.06.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><div>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.</div></div><div><h3>Objectives</h3><div>Communicate the current results of the surgical series. Describe the long-term evolution based on the persistence of pulmonary hypertension.</div></div><div><h3>Material and methods</h3><div>Until December 2023 we have performed 405 procedures. Right heart catheterization was obtained in 301 patients at 6<!--> <!-->months.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":42671,\"journal\":{\"name\":\"Cirugia Cardiovascular\",\"volume\":\"32 5\",\"pages\":\"Pages 237-243\"},\"PeriodicalIF\":0.3000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cirugia Cardiovascular\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1134009624001086\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cirugia Cardiovascular","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1134009624001086","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}
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.