Editor-in-Chief Ufuk Demirkılıç Frequency Quarterly Abbreviation Turk J Vasc Surg Publisher Turkish National Vascular and Endovascular Surgery Society ISSN 2667-4947 E-ISSN 2667-5080



Turkish Journal of Vascular Surgery 2021 , Vol 30 , Issue 3
Management of high-risk chronic thromboembolic pulmonary hypertension patients
Gökçen Orhan1, Nehir Selçuk1, Hüseyin Kuplay1, Mustafa Şimşek3, Sena Sert2, Müge Mete1, Şebnem Albeyoğlu1
1Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
2Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
3Department of Anesthesiology and Reanimation, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
DOI : 10.9739/tjvs.2021.949 Objectives: In this study, we present our surgical results and postoperative management in high-risk chronic thromboembolic pulmonary hypertension (CTEPH) patients undergoing pulmonary thromboendarterectomy (PTE).

Patients and methods: Between December 2015 and December 2020, a total of nine patients with CTEPH (6 males, 3 females; median age: 52 years; range, 34 to 67 years) who were at high risk for mortality and underwent PTE in our cardiovascular surgery clinic were retrospectively analyzed. The PTE procedure was performed under cardiopulmonary bypass through total circulatory arrest. Pre- and postoperative data were compared.

Results: Of the patients with CTEPH, two had a hydatid cyst, two had a malignant tumor, and five had advanced right heart failure with poor end organ functions. Two patients required an additional intervention including tricuspid ring annuloplasty and atrial septal defect closure in each. Preoperatively, the mean pulmonary artery pressure (mPAP) was 78±22 mmHg, mean pulmonary vascular resistance (PVR) was 13±2.5 Wood Units, mean cardiac index (CI) was 1.27±0.6 L/min/m2, and mean cardiac output (CO) was 2.62±0.5 L/min. Preoperatively, the mean systemic vascular resistance (SVR) was 25±1.5 Wood units and mean left ventricular ejection fraction (LVEF) was 55.5±%.

Conclusion: The PTE procedure is the gold-standard treatment of CTEPH. Patients diagnosed with CTEPH should be immediately referred to a PTE center, before the onset of persistent arteriopathy. Keywords : Chronic thromboembolic pulmonary hypertension, progressive right heart failure, pulmonary hypertension, pulmonary thromboendarterectomy

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