open access publication

Article, 2023

Long-term effects of pulmonary endarterectomy on pulmonary hemodynamics, cardiac function, and exercise capacity in chronic thromboembolic pulmonary hypertension

The Journal of Heart and Lung Transplantation, ISSN 1053-2498, 1557-3117, Volume 43, 4, Pages 580-593, 10.1016/j.healun.2023.11.011

Contributors

Kianzad, Azar 0000-0003-1238-4139 [1] [2] Baccelli, Andrea [3] [4] Braams, Natalia Joanna [1] [2] Andersen, Stine 0000-0002-7153-1170 [5] Van Wezenbeek, Jessie C C 0000-0002-1091-5445 [1] [2] Wessels, Jeroen N 0000-0003-2401-7707 [1] [2] Celant, Lucas R 0000-0001-6727-7539 [1] [2] Vos, Anna E [2] Davies, Rachel [6] Giudice, Francesco Lo [6] Haji, Gulammehdi [6] Rinaldo, Rocco Francesco 0000-0003-3999-5298 [3] Vigo, Beatrice [3] Gopalan, Deepa 0000-0001-8079-205X [6] Symersky, Petr 0000-0002-5181-881X [2] Winkelman, Jacobus A 0000-0002-8873-4839 [2] Boonstra, Anco B [1] [2] Nossent, Esther J 0000-0003-3854-4137 [1] [2] Marcus, Johan T 0000-0001-9948-6407 [1] [2] Noordegraaf, Anton Vonk- 0000-0002-4057-758X [1] [2] Meijboom, Lilian Jacoba [1] [2] De Man, Frances Sarah 0000-0002-5776-7793 [1] [2] Andersen, Asger 0000-0002-9102-3130 [5] Howard, Luke S G E 0000-0003-2822-210X [4] [6] Bogaard, Harm Jan 0000-0001-5371-0346 (Corresponding author) [1] [2]

Affiliations

  1. [1] Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, the Netherlands
    2. [NORA names: Netherlands; Europe, EU; OECD];
  2. [2] Amsterdam University Medical Centers
    3. [NORA names: Netherlands; Europe, EU; OECD];
  3. [3] University of Milan
    4. [NORA names: Italy; Europe, EU; OECD];
  4. [4] Imperial College London
    5. [NORA names: United Kingdom; Europe, Non-EU; OECD];
  5. [5] Aarhus University Hospital
    6. [NORA names: Central Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD];

Abstract

BACKGROUND: Long-term changes in exercise capacity and cardiopulmonary hemodynamics after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) have been poorly described. METHODS: We analyzed the data from 2 prospective surgical CTEPH cohorts in Hammersmith Hospital, London, and Amsterdam UMC. A structured multimodal follow-up was adopted, consisting of right heart catheterization, cardiac magnetic resonance imaging, and cardiopulmonary exercise testing before and after PEA. Preoperative predictors of residual pulmonary hypertension (PH; mean pulmonary artery pressure >20 mm Hg and pulmonary vascular resistance ≥2 WU) and long-term exercise intolerance (VO2max <80%) at 18 months were analyzed. RESULTS: A total of 118 patients (61 from London and 57 from Amsterdam) were included in the analysis. Both cohorts displayed a significant improvement of pulmonary hemodynamics, right ventricular (RV) function, and exercise capacity 6 months after PEA. Between 6 and 18 months after PEA, there were no further improvements in hemodynamics and RV function, but the proportion of patients with impaired exercise capacity was high and slightly increased over time (52%-59% from 6 to 18 months). Long-term exercise intolerance was common and associated with preoperative diffusion capacity for carbon monoxide (DLCO), preoperative mixed venous oxygen saturation, and postoperative PH and right ventricular ejection fraction (RVEF). Clinically significant RV deterioration (RVEF decline >3%; 5 [9%] of 57 patients) and recurrent PH (5 [14%] of 36 patients) rarely occurred beyond 6 months after PEA. Age and preoperative DLCO were predictors of residual PH post-PEA. CONCLUSIONS: Restoration in exercise tolerance, cardiopulmonary hemodynamics, and RV function occurs within 6 months. No substantial changes occurred between 6 and 18 months after PEA in the Amsterdam cohort. Nevertheless, long-term exercise intolerance is common and associated with postoperative RV function.

Keywords

Amsterdam, Amsterdam UMC, Amsterdam cohort, DLCO, Hammersmith, Hammersmith Hospital, London, RV deterioration, RV function, UMC, age, analysis, capacity, carbon, carbon monoxide, cardiac function, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, cardiopulmonary hemodynamics, catheterization, changes, chronic thromboembolic pulmonary hypertension, clinic, cohort, data, deterioration, diffusing capacity, effect of pulmonary endarterectomy, ejection fraction, endarterectomy, exercise, exercise capacity, exercise intolerance, exercise test, exercise tolerance, follow-up, fraction, function, heart catheterization, hemodynamics, hospital, hypertension, images, impaired exercise capacity, improvement, improvement of pulmonary hemodynamics, intolerance, long-term changes, long-term effects, magnetic resonance imaging, mixed venous oxygen saturation, monoxide, months, multimodal follow-up, oxygen saturation, patients, post-PEA, postoperative PH, postoperative RV function, predictors, preoperative diffusion capacity, preoperative predictors, proportion, proportion of patients, pulmonary endarterectomy, pulmonary hemodynamics, pulmonary hypertension, recurrent PH, residual pulmonary hypertension, resonance imaging, restoration, right heart catheterization, right ventricular (RV) function, right ventricular ejection fraction, rights, saturation, test, thromboembolic pulmonary hypertension, time, tolerance, venous oxygen saturation, ventricular ejection fraction

Funders

  • Hartstichting

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