Chronic thromboembolic pulmonary hypertension: clinical evolution and surgical treatment (Hipertensión pulmonar tromboembólica crónica: evolución clínica y tratamiento quirúrgico)

Background: Chronic thromboembolic pulmonary hypertensionis a complication of acute major pulmonary embolism or multipleepisodes of pulmonary thromboembolism.Objective: It is to Analyze clinical and demographic characteristicsand risk factors of our population with pulmonary thromboendarterectomy.Methods: 43 consecutive patients with pulmonary thromboendarterectomywere retrospectively analyzed between November 1992and August 2010. Two patients were excluded for pulmonary angiosarcomadiagnosis. Selection criteria: dyspnea, mean pulmonarypressure >30mmHg, pulmonary vascular resistance >300 dyne/seg/cm-5, complete blockage of a principal pulmonary artery, proximalobstruction of lobar or segmental arteries and no significant comorbidities.The event-free survival was calculated using a Kaplan-Meier analysis. It was considered statistically significant a p-value≤ 0.05.Results: 44% of patients presented functional dyspnea class IV,61% severe dysfunction of right ventricular and 58% moderate tosevere tricuspid regurgitation. A history of deep vein thrombosiswas identified in 52% of the cases, acute pulmonary embolism in41% and 29% both. Thrombophilia was diagnosed in 51% of patients.During the postoperative, pulmonary pressures and resistancesshowed a significant decrease (p <0,001). Overall survival at 1,2, 5 and 10 years was 85%, 82%, 75% and 71% respectively withsignificant differences (p = 0,02).Conclusion: Pulmonary thromboendarterectomy was an effectivetreatment in high risk patients, improving hemodynamics and survival. -RESUMEN: Introducción: La hipertensión pulmonar tromboembólica crónicaes una complicación de un embolismo pulmonar agudo mayor omúltiples episodios de tromboembolismo pulmonar.Objetivo: Analizar las características clínicas, demográficas y factoresde riesgo de nuestra población con tromboendarterectomíapulmonar.Material y Métodos: Se analizaron retrospectivamente 43 pacientesconsecutivos con tromboendarterectomía pulmonar entreNoviembre 1992 y Agosto 2010. Dos pacientes fueron excluidosdel análisis por diagnóstico de angiosarcoma pulmonar. Criteriosde selección: disnea, presión arterial pulmonar media > 30 mmHg,resistencia vascular pulmonar > 300 dinas/seg/cm-5, obstruccióncompleta de una arteria pulmonar principal, obstrucción proximalde arterias lobares o segmentarias y ausencia de comorbilidadessignificativas. La supervivencia libre de eventos se calculó utilizandoun análisis de Kaplan-Meier. Se consideró estadísticamentesignificativo un valor de p ≤ 0.05.Resultados: Presentaban disnea en clase funcional IV el 44% delos pacientes, dis