背景:慢性血栓栓塞性肺动脉高压(CTEPH)的外科治疗具有挑战性。大多数葡萄牙CTEPH患者已被转诊到外国机构接受治疗,巨大的社会和经济成本。为了满足这一新兴需求,圣玛尔塔医院心胸外科,里斯本,已经开发了肺血栓内膜切除术(PTE)的专用程序。我们在此介绍治疗的前19名患者的结果。
方法:我们对2008年至2019年4月在圣玛尔塔医院接受PTE的所有19例患者进行了回顾性分析。
结果:自2008年以来,我们部门共有19名患者接受了PTE。该程序在生存和功能恢复方面均取得了良好的结果。在系列开始时,两名患者围手术期死亡,在所有团队都在皇家帕普沃斯医院接受正式训练之前,英国,此后没有过早死亡。术后并发症与其他发表的系列相似。在11年的随访中,有三个晚期死亡,均为残余肺动脉高压患者。在最新的随访中(2019年10月),所有存活的患者都表现出显著的功能恢复,都在NYHA一级或二级,只有一名患者接受了西地那非的血管舒张治疗(该系列中的第一位,2008年运营)。
结论:PTE是一个要求很高的程序,结果与数量和积累的经验有关,然而,它可以安全地进行,并具有可重复的结果由一个适当准备的专业团队和一个良好控制的学习曲线.需要更多的患者和多学科经验来进一步改善和简化结果。
BACKGROUND: Surgical treatment for chronic thromboembolic pulmonary hypertension (CTEPH) is challenging. Most Portuguese patients with CTEPH have been referred to foreign institutions for treatment, with significant social and economic costs. To meet this emerging need, the cardiothoracic surgery department of Hospital de Santa Marta, Lisbon, has developed a dedicated program for pulmonary thromboendarterectomy (PTE). We hereby present the results for the first 19 patients treated.
METHODS: We conducted a retrospective analysis of all 19 patients who underwent PTE at Hospital de Santa Marta between 2008 and April 2019.
RESULTS: Since 2008, a total of 19 patients have undergone PTE in our department. The procedure was performed with good outcomes in both survival and functional recovery. At the very beginning of the series two patients died perioperatively, before all the team underwent formal training at the Royal Papworth Hospital, UK, with no early deaths since. Postoperative complications were similar to other published series. During 11 years of follow-up, there were three late deaths, all in patients with residual pulmonary arterial hypertension. At the latest follow-up (October 2019), all surviving patients showed significant functional recovery, all in NYHA class I or II, with only one patient on vasodilator therapy with sildenafil (the first in the series, operated in 2008).
CONCLUSIONS: PTE is a demanding procedure, in which outcomes are related to volume and accumulated experience, however it can be performed safely and with reproducible results by a properly prepared dedicated team with a well-controlled learning curve. More patients and multidisciplinary experience will be needed to further improve and streamline results.