Cor Vasa 2015, 57(2):e115-e120 | DOI: 10.1016/j.crvasa.2015.02.009

Pulmonary endarterectomy combined with cardiac surgery: A 7-year retrospective analysis

Jaroslav Lindner^a,*, David Ambrož^b, Róbert Novotný^a, Matúš Nižňanský^a, Iveta Šimková^c, Marcela Boháčeková^c, Ondrej Pecha^d, Pavel Jansa^b

^a II. chirurgická klinika - kardiovaskulární chirurgie, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice, Praha, Česká republika

^b II. interní klinika kardiologie a angiologie, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice, Praha, Česká republika

^c Klinika kardiológie a angiológie, Lekárska fakulta Slovenskej zdravotníckej univerzity a Národný ústav srdcových a cievnych chorôb, Bratislava, Slovenská republika

^d Technologické centrum Akademie věd České republiky, Praha, Česká republika

Background: Pulmonary artery endarterectomy (PEA) is established as a successful method for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). A significant fraction of patients indicated for the pulmonary endarterectomy has other severe comorbidities that generally increase the risk of cardiac surgery. The aim of our study is to analyze the process of indications and therapeutic procedures at our Cardio-Centre, as well as comparing hemodynamic parameters and long-term results in order to determine the continuation of the treatment.

Method: From September 2004 to August 2012, 192 patients underwent PEA for CTEPH. We carried out a retrospective analysis of patients' data. Patients were divided into two groups: A and B. The group A included patients with PEA only (128 patients), group B consisted of patients with PEA and another cardiac procedure (64 patients, i.e. 33.3% of which 72 cardiac procedures were carried out). Group B was further subdivided into group B1 - patients with PEA + CABG, which included 25 patients, and group B2 - PEA + suture of PFO, which consisted of 29 patients for more detailed analysis.

Results: Five-year survival rate is 83% in group A, 79.3% in group B, and 63.1% in group B1. Group B1 is statistically significantly different from group A (p = 0.031). The cumulative survival rate is comparable for groups A and B2. Cumulative survival rate is very good with annual survival in group A - 94%, group B2 - 90% and group B1 - 82.6%.

Conclusion: Results of combined interventions are comparable with isolated pulmonary endarterectomy. We did not find any differences in hemodynamic effects. All patients indicated for the PEA should be screened for the most common comorbidities regardless of their age. We recommend implementation CryoMAZE for the treatment of atrial fibrillation or atrial flutter.

Keywords: Atrial fibrillation; Cardiac surgery; CryoMAZE; CTEPH; Pulmonary endarterectomy

Received: January 19, 2015; Accepted: February 17, 2015; Published: April 1, 2015  Show citation