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Am. J. Respir. Crit. Care Med., Volume 160, Number 2, August 1999, 523-528

Long-Term Outcome after Pulmonary Thromboendarterectomy

CAROL J. ARCHIBALD, WILLIAM R. AUGER, PETER F. FEDULLO, RICHARD N. CHANNICK, KIM M. KERR, STUART W. JAMIESON, DAVID P. KAPELANSKI, CONSTANCE N. WATT, and KENNETH M. MOSER

Division of Pulmonary and Critical Care Medicine and Division of Cardiothoracic Surgery, University of California, San Diego, San Diego, California

This study evaluated long-term outcome of pulmonary thromboendarterectomy (PTE) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Survival, functional status, quality of life, health care utilization, and relationships between these parameters and postoperative pulmonary hemodynamics were assessed. Questionnaires were mailed to 420 patients who were more than 1 yr post-PTE; 308 responded (mean age, 56 yr [range, 19-89 yr]; mean years since PTE, 3.3 [range, 1- 16]). Survival after PTE was 75% at > 6 yr. After surgery, symptoms were markedly reduced. Median distance walked was 5,280 ft; 56 patients could walk "indefinitely." Of the working population, 62% of patients unemployed before PTE returned to work. Post-PTE patients scored several quality of life components of the Rand SF-36 slightly lower than reported normals but significantly higher than did pre-PTE patients. Ten percent of patients used oxygen. Ninety-three percent were in NYHA Class I or II. Disease-related hospitalizations/ER visits were minimal. A relationship was shown between 48 h postoperative pulmonary vascular resistance (PVR) and walking and stair-climbing ability, NYHA class, dyspnea scores, and the physical function and general health quality of life components. These data indicate that PTE offers most CTEPH patients substantial improvement in survival, function, and quality of life, with minimal disease-related health care utilization.




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