Objective To evaluate the improving reliability and safety of thromboendarterectomy and perioperative management for chronic pulmonary thromboembolism. Methods The clinical data of 12 cases with chronic pulmonary thro...Objective To evaluate the improving reliability and safety of thromboendarterectomy and perioperative management for chronic pulmonary thromboembolism. Methods The clinical data of 12 cases with chronic pulmonary thromboembolism, who underwent thromboendarterec- tomy assisted by low flow or circulation arrest with deep hypothermia, were reviewed retrospectively. Results Pulmonary artery pressure decreased 20 to 40 mmHg immediately after surgical procedures in 9 cases. The postoperative pulmonary edema at various degrees happened in 12 cases, among them, 1 died of severe lung infection and pulmonary re-embolism at 19 days postoperation. Computed tomography pulmonary angiography and angiography of 11 cases indicated that the original obstruction of pulmonary artery disappeared. During the follow-up period of 2 months to 5 years, the clinical symptoms and activity was improved. Conclusion Thromboendarterectomy is an effective treatment for chronic pulmonary thromboembolism. The outcome of the surgical procedure needs to be further investigated and followed up regularly according to an evaluative system, because it might be influenced by multiple factors.展开更多
Objective: To study the outcome of normothermic beating heart pulmonary thromboendarterectomy (PTE) performed in patients with chronic pulmonary thromboembolism. Methodology: A retrospective analysis of 15 patients wh...Objective: To study the outcome of normothermic beating heart pulmonary thromboendarterectomy (PTE) performed in patients with chronic pulmonary thromboembolism. Methodology: A retrospective analysis of 15 patients who underwent PTE under normothermic beating heart cardio-pulmonary bypass from July 2009 to September 2018 was done. The patients were followed up with clinical assessment, transthoracic echocardiography and computerized tomographicangiography (CTA) for 1 month to 82 months. Results: Data were analysed for 15 consecutive patients. Mean age of the patients was 35.28 years and 10 patients were male. Pre-operatively 6 (40%) patients presented with New York Heart Association (NYHA) class II dyspnoea on exertion symptomatology, 7 (47%) were in NHYA class III, and 2 (13%) were in NYHA class IV. The preoperative and postoperative mean pulmonary artery pressures (mPAP) (mmHg) were 36.50 ± 11.3 and 20.21 ± 7.19, the systolic PAPs (mmHg) were 73.35 ± 14.12 and 35.21 ± 7.89 and the diastolic PAPs (mmHg) were 19.28 ± 8.60 and 12.85 ± 7.26 respectively. 2 (13%) patients had Jamieson’s type I and 12 (87%) had Jamieson type II disease. One patient (7%) expired on 9th postoperative day. All the patients had improved pulmonary gas exchange and did not require oxygen supplementation from 5th postoperative day;symptoms improved to NYHA class I & II in 12 (80%) & 3 (20%) of patients respectively. There was no reperfusion pulmonary edema or any neurologic complications. Postoperative echocardiogram showed improved right ventricular function and Computerised Tomographic Angiogram showed completeness of the procedure. Conclusion: Pulmonary thromboendarterectomy under normothermic beating heart cardiopulmonary bypass has good immediate postoperative results with significant progressive improvement in hemodynamics and quality of life during the course of follow-up. The results were not only comparable to those of the procedure done under deep hypothermic circulatory arrest by other centres but also without its associated adverse events. This technique requires more expertise but gives equivalent good results in immediate and short- to mid-term follow-up with less morbidity than the standard procedure, but it requires long-term follow-up to substantiate the evidence.展开更多
Chronic thromboembolic pulmonary hypertension is one of the few forms of pulmonary hypertension that can be cured surgically, being the pulmonary trhomboendarterectomy (PTE) the therapeutic approach of choice, with su...Chronic thromboembolic pulmonary hypertension is one of the few forms of pulmonary hypertension that can be cured surgically, being the pulmonary trhomboendarterectomy (PTE) the therapeutic approach of choice, with survival as high as 75% to 90% at 5 years. Our case report focuses on the intraoperative use on the transesophageal echocardiography, which has proven to be of outmost utility in PTE surgery. Two cases of pulmonary thromboendarterectomy are described, in which transesophageal echocardiography was the key factor in the intraoperative management, indicating the initiation time of nitric oxide in case number one and contraindicating the advancement of the pulmonary artery catheter in case number two, due to a mobile thrombus located in the right ventricular outflow tract.展开更多
Objective: The gold standard procedure for pulmonary thromboendarterectomy is median sternotomy, cardiopulmonary bypass, profound hypothermia (18oC) and circulatory arrest. We propose a modified technique to improve t...Objective: The gold standard procedure for pulmonary thromboendarterectomy is median sternotomy, cardiopulmonary bypass, profound hypothermia (18oC) and circulatory arrest. We propose a modified technique to improve the quality of care in this patient population, based on an intervention previously used in aortic surgery. Method: In our modified technique, we cannulated the right axillary artery to allow antegrade brain perfusion while on circulatory arrest. In this retrospective study, we have reviewed the data relating to the first 7 patients on whom we performed the modified technique and have made comparison with a group of 7 case-matched individuals who underwent the standard technique (control group). Results: The modified technique allowed for use of moderate hypothermia (25oC - 28oC). Patients in both groups woke up without neurologic complications. A trend towards, but non-significant reduction in duration of surgery from 303 (±42) to 279 (±44), duration of postoperative inotropic support from 2.7 ± 3.4 days to 1.7 ± 2.0 days, as well as postoperative mechanical ventilation time from 4.87 (±3.7) to 2 (±2.7) days were seen in the control and modified groups respectively. All patients in the modified group woke up on post-operative day 0, whereas most patients in the control group awoke on postoperative day 1. No significant differences were noted in the reduction in preoperative to postoperative systolic pulmonary artery pressure, post-operative length of stay in the intensive care unit and length of stay in the hospital among the two groups. Conclusions: The antegrade brain perfusion via the right axillary artery allows for good brain protection, while maintaining a bloodless field in the arterial pulmonary tree. All our patients awoke without any neurologic deficits. In the future, by using an even milder level of cooling, we may be able to significantly reduce the duration of surgery and improve the recovery of our patients.展开更多
Introduction: For the treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) thromboendarterectomy (PTE) is increasingly performing with deep hypothermic circulatory arrest (DHCA). At the las...Introduction: For the treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) thromboendarterectomy (PTE) is increasingly performing with deep hypothermic circulatory arrest (DHCA). At the last time, there are some publications with describing of the PTE performance without DHCA. Objective: To analyze and evaluate the results of surgical treatment of CTEPH under cardiopulmonary bypass (CPB), cardioplegia and without DHCA. Methods: Retrospective analysis of the PTE results in 70 patients operated on from January 2018 to February 2023 was conducted. Evaluation pre- and postoperative clinical examinations and invasive pulmonary artery pressure (PAP) measurement in all patients involved were systematically analyzed. Results: The average age of the patients was 48.1 ± 10.5 years, including 44.3 % males and 55.7 % females. Due to New York Heart Association (NYHA), 6 (8.6%) patients preoperatively belonged to class II, 48 (68.6%) to class III and 16 (22.9%) to class IV. The thrombotic masses structure according to Jamieson’s classification belonged to type I in 42 (60%) patients and to type II in 28 (40%) patients. Postoperatively the systolic PAP (PAPs, mmHg) decreased from 80.8 ± 22.9 to 40.8 ± 13.5, the mean pressure (mPAP, mmHg)—from 48.5 ± 14.4 to 25.3 ± 7.3, respectively. Four patients died. The in-hospital mortality rate was 5.7%. According to NYHA, the clinical conditions have also improved: class I was observed in 48 (73%) patients, class II in 15 (23%) and class III in 3 (4%) patients. The postoperative transthoracic echocardiogram (TEE) revealed an improvement of the right ventricle (RV) function and computed tomography (CT) angiogram demonstrated a positive dynamic and a surgery adequacy. Conclusion: PTE under CPB without DHCA can lead to immediate positive results with significant improvements in hemodynamic parameters and life quality without typical DHCA complications in patients with thrombi type I and II according to Jamieson’s classification.展开更多
Background Pulmonary thromboendarterectomy （PTE） has evolved as a treatment of choice for chronic thromboembolic pulmonary hypertension （CTEPH）. This study aimed to characterize if pulmonary oligemia maneuver （PO...Background Pulmonary thromboendarterectomy （PTE） has evolved as a treatment of choice for chronic thromboembolic pulmonary hypertension （CTEPH）. This study aimed to characterize if pulmonary oligemia maneuver （POM） can alleviate pulmonary artery injury during PTE procedure. Methods A total of 112 cases of CTEPH admitted to Beijing Anzhen Hospital from March 2002 to August 2011 received PTE procedure. They were retrospectively classified as non-POM group （group A, n=55） or POM group （group B, n=57）. Members from group B received POM during rewarming period, whereas members from group A did not. Results There were three （5.45%） early deaths in group A, no death in group B （0） （Fisher＇s exact test, P=0.118）. Six patients in group A needed extracorporeal membrane oxygenation （ECMO） as life support after the PTE procedure, no patients in group B needed ECMO （Fisher＇s exact test, P=0.013）. The patients in group B had a shorter intubation and ICU stay, lower mean pulmonary arterial pressure （mPAP） and pulmonary vascular resistance （PVR）, higher partial pressure of oxygen in artery （PaO2） and arterial oxygen saturation （SaO2） and less medical expenditure than patients in group A. With a mean follow-up time of （58.3 ± 30.6） months, two patients in group A and one patient in group B died. The difference of the actuarial survival after the procedure between the two groups did not reach statistical significance. Three months post the PTE procedure, the difference of residual occluded pulmonary segment between the two groups did not reach statistical significance （P=0.393）. Conclusion POM can alleviate pulmonary artery injury, shorten ICU stay and intubation time, and lower down the rate of ECMO after PTE procedure.展开更多
Pulmonary thromboendarterectomy (PEA) is the recommended treatment for chronic thromboembolic pulmonary hypertension (CTEPH).Pulmonary artery injury is a major risk factor during PEA performed at less experienced surg...Pulmonary thromboendarterectomy (PEA) is the recommended treatment for chronic thromboembolic pulmonary hypertension (CTEPH).Pulmonary artery injury is a major risk factor during PEA performed at less experienced surgical centers and is associated with adverse short-term consequences.In-hospital mortality may be as high as 15% in some PEA case series,with pulmonary artery injury and persistent pulmonary hypertension as the principal etiologies.Many techniques have been used to prevent pulmonary artery injury during PEA,but once the injury occurs,the prognosis is poor and may even result in death.Out of 202 PEA procedures performed at our surgical center,we successfully managed two cases of severe pulmonary artery injury and report our experience in the present case series.展开更多
Importance of?thrombendarterectomy (TEA) had declined with the advent of bypass techniques and availability of prosthetic grafts, in patients with Peripheral arterial occlusive disease (PAOD). Recently, there had been...Importance of?thrombendarterectomy (TEA) had declined with the advent of bypass techniques and availability of prosthetic grafts, in patients with Peripheral arterial occlusive disease (PAOD). Recently, there had been a significant shift towards lower limb revascularization using endoluminal techniques. However, previously available data evaluating the long leg bypass or combined endoluminal and bypass procedures have been too anatomically heterogeneous to be easily applied to patients with infrainguinal disease and tissue loss. Clinical decision making in Complex multilevel or diffuse peripheral arterial occlusive disease with multiple co-morbidities especially associated coronary arterial disease is challenging. We describe twelve patients of iliofemoral arterial occlusive disease with tibiopopliteal arterial occlusive disease along with multiple co-morbidities like coronary arterial disease and diabetes mellitus who showed marked improvement with minimal post-operative?morbidities after iliofemoral or ileopopliteal bypass grafting with endarterectomy of the tibiopopliteal segment and related review of the literature.展开更多
文摘Objective To evaluate the improving reliability and safety of thromboendarterectomy and perioperative management for chronic pulmonary thromboembolism. Methods The clinical data of 12 cases with chronic pulmonary thromboembolism, who underwent thromboendarterec- tomy assisted by low flow or circulation arrest with deep hypothermia, were reviewed retrospectively. Results Pulmonary artery pressure decreased 20 to 40 mmHg immediately after surgical procedures in 9 cases. The postoperative pulmonary edema at various degrees happened in 12 cases, among them, 1 died of severe lung infection and pulmonary re-embolism at 19 days postoperation. Computed tomography pulmonary angiography and angiography of 11 cases indicated that the original obstruction of pulmonary artery disappeared. During the follow-up period of 2 months to 5 years, the clinical symptoms and activity was improved. Conclusion Thromboendarterectomy is an effective treatment for chronic pulmonary thromboembolism. The outcome of the surgical procedure needs to be further investigated and followed up regularly according to an evaluative system, because it might be influenced by multiple factors.
文摘Objective: To study the outcome of normothermic beating heart pulmonary thromboendarterectomy (PTE) performed in patients with chronic pulmonary thromboembolism. Methodology: A retrospective analysis of 15 patients who underwent PTE under normothermic beating heart cardio-pulmonary bypass from July 2009 to September 2018 was done. The patients were followed up with clinical assessment, transthoracic echocardiography and computerized tomographicangiography (CTA) for 1 month to 82 months. Results: Data were analysed for 15 consecutive patients. Mean age of the patients was 35.28 years and 10 patients were male. Pre-operatively 6 (40%) patients presented with New York Heart Association (NYHA) class II dyspnoea on exertion symptomatology, 7 (47%) were in NHYA class III, and 2 (13%) were in NYHA class IV. The preoperative and postoperative mean pulmonary artery pressures (mPAP) (mmHg) were 36.50 ± 11.3 and 20.21 ± 7.19, the systolic PAPs (mmHg) were 73.35 ± 14.12 and 35.21 ± 7.89 and the diastolic PAPs (mmHg) were 19.28 ± 8.60 and 12.85 ± 7.26 respectively. 2 (13%) patients had Jamieson’s type I and 12 (87%) had Jamieson type II disease. One patient (7%) expired on 9th postoperative day. All the patients had improved pulmonary gas exchange and did not require oxygen supplementation from 5th postoperative day;symptoms improved to NYHA class I & II in 12 (80%) & 3 (20%) of patients respectively. There was no reperfusion pulmonary edema or any neurologic complications. Postoperative echocardiogram showed improved right ventricular function and Computerised Tomographic Angiogram showed completeness of the procedure. Conclusion: Pulmonary thromboendarterectomy under normothermic beating heart cardiopulmonary bypass has good immediate postoperative results with significant progressive improvement in hemodynamics and quality of life during the course of follow-up. The results were not only comparable to those of the procedure done under deep hypothermic circulatory arrest by other centres but also without its associated adverse events. This technique requires more expertise but gives equivalent good results in immediate and short- to mid-term follow-up with less morbidity than the standard procedure, but it requires long-term follow-up to substantiate the evidence.
文摘Chronic thromboembolic pulmonary hypertension is one of the few forms of pulmonary hypertension that can be cured surgically, being the pulmonary trhomboendarterectomy (PTE) the therapeutic approach of choice, with survival as high as 75% to 90% at 5 years. Our case report focuses on the intraoperative use on the transesophageal echocardiography, which has proven to be of outmost utility in PTE surgery. Two cases of pulmonary thromboendarterectomy are described, in which transesophageal echocardiography was the key factor in the intraoperative management, indicating the initiation time of nitric oxide in case number one and contraindicating the advancement of the pulmonary artery catheter in case number two, due to a mobile thrombus located in the right ventricular outflow tract.
文摘Objective: The gold standard procedure for pulmonary thromboendarterectomy is median sternotomy, cardiopulmonary bypass, profound hypothermia (18oC) and circulatory arrest. We propose a modified technique to improve the quality of care in this patient population, based on an intervention previously used in aortic surgery. Method: In our modified technique, we cannulated the right axillary artery to allow antegrade brain perfusion while on circulatory arrest. In this retrospective study, we have reviewed the data relating to the first 7 patients on whom we performed the modified technique and have made comparison with a group of 7 case-matched individuals who underwent the standard technique (control group). Results: The modified technique allowed for use of moderate hypothermia (25oC - 28oC). Patients in both groups woke up without neurologic complications. A trend towards, but non-significant reduction in duration of surgery from 303 (±42) to 279 (±44), duration of postoperative inotropic support from 2.7 ± 3.4 days to 1.7 ± 2.0 days, as well as postoperative mechanical ventilation time from 4.87 (±3.7) to 2 (±2.7) days were seen in the control and modified groups respectively. All patients in the modified group woke up on post-operative day 0, whereas most patients in the control group awoke on postoperative day 1. No significant differences were noted in the reduction in preoperative to postoperative systolic pulmonary artery pressure, post-operative length of stay in the intensive care unit and length of stay in the hospital among the two groups. Conclusions: The antegrade brain perfusion via the right axillary artery allows for good brain protection, while maintaining a bloodless field in the arterial pulmonary tree. All our patients awoke without any neurologic deficits. In the future, by using an even milder level of cooling, we may be able to significantly reduce the duration of surgery and improve the recovery of our patients.
文摘Introduction: For the treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) thromboendarterectomy (PTE) is increasingly performing with deep hypothermic circulatory arrest (DHCA). At the last time, there are some publications with describing of the PTE performance without DHCA. Objective: To analyze and evaluate the results of surgical treatment of CTEPH under cardiopulmonary bypass (CPB), cardioplegia and without DHCA. Methods: Retrospective analysis of the PTE results in 70 patients operated on from January 2018 to February 2023 was conducted. Evaluation pre- and postoperative clinical examinations and invasive pulmonary artery pressure (PAP) measurement in all patients involved were systematically analyzed. Results: The average age of the patients was 48.1 ± 10.5 years, including 44.3 % males and 55.7 % females. Due to New York Heart Association (NYHA), 6 (8.6%) patients preoperatively belonged to class II, 48 (68.6%) to class III and 16 (22.9%) to class IV. The thrombotic masses structure according to Jamieson’s classification belonged to type I in 42 (60%) patients and to type II in 28 (40%) patients. Postoperatively the systolic PAP (PAPs, mmHg) decreased from 80.8 ± 22.9 to 40.8 ± 13.5, the mean pressure (mPAP, mmHg)—from 48.5 ± 14.4 to 25.3 ± 7.3, respectively. Four patients died. The in-hospital mortality rate was 5.7%. According to NYHA, the clinical conditions have also improved: class I was observed in 48 (73%) patients, class II in 15 (23%) and class III in 3 (4%) patients. The postoperative transthoracic echocardiogram (TEE) revealed an improvement of the right ventricle (RV) function and computed tomography (CT) angiogram demonstrated a positive dynamic and a surgery adequacy. Conclusion: PTE under CPB without DHCA can lead to immediate positive results with significant improvements in hemodynamic parameters and life quality without typical DHCA complications in patients with thrombi type I and II according to Jamieson’s classification.
基金This study was supported by grants from the National Natural Science Foundation of China （No. 81070041） and the Beijing Science and Technology Project （No. Z 121107001012067）.
文摘Background Pulmonary thromboendarterectomy （PTE） has evolved as a treatment of choice for chronic thromboembolic pulmonary hypertension （CTEPH）. This study aimed to characterize if pulmonary oligemia maneuver （POM） can alleviate pulmonary artery injury during PTE procedure. Methods A total of 112 cases of CTEPH admitted to Beijing Anzhen Hospital from March 2002 to August 2011 received PTE procedure. They were retrospectively classified as non-POM group （group A, n=55） or POM group （group B, n=57）. Members from group B received POM during rewarming period, whereas members from group A did not. Results There were three （5.45%） early deaths in group A, no death in group B （0） （Fisher＇s exact test, P=0.118）. Six patients in group A needed extracorporeal membrane oxygenation （ECMO） as life support after the PTE procedure, no patients in group B needed ECMO （Fisher＇s exact test, P=0.013）. The patients in group B had a shorter intubation and ICU stay, lower mean pulmonary arterial pressure （mPAP） and pulmonary vascular resistance （PVR）, higher partial pressure of oxygen in artery （PaO2） and arterial oxygen saturation （SaO2） and less medical expenditure than patients in group A. With a mean follow-up time of （58.3 ± 30.6） months, two patients in group A and one patient in group B died. The difference of the actuarial survival after the procedure between the two groups did not reach statistical significance. Three months post the PTE procedure, the difference of residual occluded pulmonary segment between the two groups did not reach statistical significance （P=0.393）. Conclusion POM can alleviate pulmonary artery injury, shorten ICU stay and intubation time, and lower down the rate of ECMO after PTE procedure.
基金supported by grants from the China Nature Science Foundation Committee(No.81070041)the Beijing Health System Special Foundation for Building High-Level Health Personnel(No.2013-2-002)the Beijing Science and Technology Project(No.Z121107001012067).
文摘Pulmonary thromboendarterectomy (PEA) is the recommended treatment for chronic thromboembolic pulmonary hypertension (CTEPH).Pulmonary artery injury is a major risk factor during PEA performed at less experienced surgical centers and is associated with adverse short-term consequences.In-hospital mortality may be as high as 15% in some PEA case series,with pulmonary artery injury and persistent pulmonary hypertension as the principal etiologies.Many techniques have been used to prevent pulmonary artery injury during PEA,but once the injury occurs,the prognosis is poor and may even result in death.Out of 202 PEA procedures performed at our surgical center,we successfully managed two cases of severe pulmonary artery injury and report our experience in the present case series.
文摘Importance of?thrombendarterectomy (TEA) had declined with the advent of bypass techniques and availability of prosthetic grafts, in patients with Peripheral arterial occlusive disease (PAOD). Recently, there had been a significant shift towards lower limb revascularization using endoluminal techniques. However, previously available data evaluating the long leg bypass or combined endoluminal and bypass procedures have been too anatomically heterogeneous to be easily applied to patients with infrainguinal disease and tissue loss. Clinical decision making in Complex multilevel or diffuse peripheral arterial occlusive disease with multiple co-morbidities especially associated coronary arterial disease is challenging. We describe twelve patients of iliofemoral arterial occlusive disease with tibiopopliteal arterial occlusive disease along with multiple co-morbidities like coronary arterial disease and diabetes mellitus who showed marked improvement with minimal post-operative?morbidities after iliofemoral or ileopopliteal bypass grafting with endarterectomy of the tibiopopliteal segment and related review of the literature.
