Use of medical therapies before pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension patients with severe hemodynamic impairment
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Citações na Scopus
9
Tipo de produção
article
Data de publicação
2020
Título da Revista
ISSN da Revista
Título do Volume
Editora
PUBLIC LIBRARY SCIENCE
Citação
PLOS ONE, v.15, n.5, article ID e0233063, 9p, 2020
Resumo
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism, characterized by non-resolving fibro-thrombotic obstructions of large pulmonary arteries. Pulmonary endarterectomy (PEA) is the treatment of choice for the disease, significantly improving survival. Patients with worse hemodynamic profile have worse prognosis after surgery, raising the question of whether the use of medical therapy prior to surgery to optimize hemodynamics could improve outcomes. The aim of this study was to evaluate the role of medical therapy pre-PEA, according to the hemodynamic profile at the diagnosis. We retrospectively analyzed all patients submitted to PEA, from January 2013 to December 2017. Functional, clinical and hemodynamic data were collected to evaluate the main prognostic determinants. Patients were stratified according to the hemodynamic severity and use of targeted therapies prior to surgery. A total of 108 patients were included. Thirty-five patients (32,4%) used targeted therapy pre-PEA. The use of medical therapy delayed the surgical procedure by about 7 months. There was no difference in overall survival between patients that received targeted therapy and those treated only with supportive therapy (87.8% vs 80.3%, respectively, p = 0.426). Nevertheless, when analyzing the group of patients with severe hemodynamic impairment, defined by low cardiac output(< 3.7L/min) at baseline, patients treated with targeted therapies presented a significantly better one-year survival. In higher-risk CTEPH patients, characterized by the presence of low cardiac output, the use of targeted therapies prior to PEA was associated with better outcome, suggesting a potential role for pre-operative use of medical treatment in this particular subgroup.
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Referências
- Cabrol S, 2007, J HEART LUNG TRANSPL, V26, P357, DOI 10.1016/j.healun.2006.12.014
- Delcroix M, 2016, CIRCULATION, V133, P859, DOI 10.1161/CIRCULATIONAHA.115.016522
- Dias B, 2010, CIRCULATION, V122, pE1, DOI 10.1161/CIRCULATIONAHA.109.915041
- Dorfmuller P, 2014, EUR RESPIR J, V44, P1275, DOI 10.1183/09031936.00169113
- Galie N, 2016, EUR HEART J, V37, P67, DOI 10.1093/eurheartj/ehv317
- Ghofrani HA, 2003, AM J RESP CRIT CARE, V167, P1139, DOI 10.1164/rccm.200210-1157BC
- Ghofrani HA, 2017, LANCET RESP MED, V5, P785, DOI 10.1016/S2213-2600(17)30305-3
- Ghofrani HA, 2013, NEW ENGL J MED, V369, P319, DOI 10.1056/NEJMoa1209657
- Jensen KW, 2009, CIRCULATION, V120, P1248, DOI 10.1161/CIRCULATIONAHA.109.865881
- Konstantinides SV, 2014, EUR HEART J, V35, P3033, DOI 10.1093/eurheartj/ehu283
- Mayer E, 2011, J THORAC CARDIOV SUR, V141, P702, DOI 10.1016/j.jtcvs.2010.11.024
- MOSER KM, 1993, CHEST, V103, P685, DOI 10.1378/chest.103.3.685
- Simonneau G, 2017, EUR RESPIR REV, V26, P143
- Skoro-Sajer N, 2007, J THROMB HAEMOST, V5, P483, DOI 10.1111/j.1538-7836.2007.02394.x
- Yi ES, 2000, AM J RESP CRIT CARE, V162, P1577, DOI 10.1164/ajrccm.162.4.9912131
Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/09
Artigos e Materiais de Revistas Científicas - LIM/11
Artigos e Materiais de Revistas Científicas - LIM/61
Carregar mais Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/09
Artigos e Materiais de Revistas Científicas - LIM/11
Artigos e Materiais de Revistas Científicas - LIM/61