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Title Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension: The Singapore Experience |
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Type Free Paper Session 3 |
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Theme ACC Asia & SCS 32nd Annual Scientific Meeting |
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Topic Non-Invasive Cardiac Imaging, Echocardiography, Nuclear Cardiology / Adult Congenital Heart Disease / Cardiac Surgery |
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Main Author Alicia Chia1 |
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Presenting Author Alicia Chia1 |
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Co-Author Jonathan Yap 2 Wen Ruan2 Ju Le Tan2 Kenny Loh3 Ming Huat Goh3 Narayan Lath4 Foong Koon Cheah4 Ghee Chee Phua5 Duu Wen Sewa5 Aileen Ang6 Lai Heng Lee6 Mee Yong Loi1 Tanee Chan1 Kelvin Quah2 Adila binte Ismail2 Soo Teik Lim 2 David Jenkins7 Victor Chao1 |
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Department / Institution / Country Cardiothoracic Surgery / National Heart Centre Singapore / Singapore1 Cardiology / National Heart Centre Singapore / Singapore2 Anaesthesia / Singapore General Hospital / Singapore3 Radiology / Singapore General Hospital / Singapore4 Respiratory Medicine / Singapore General Hospital / Singapore5 Haematology / Singapore General Hospital / Singapore6 Cardiothoracic Surgery / Royal Papworth Hospital / United Kingdom7 |
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Objective(s) Chronic thromboembolic pulmonary hypertension (CTEPH) is a debilitating condition that portends significant mortality and morbidity. Pulmonary endarterectomy (PEA) has been shown to be an efficacious treatment of this chronic disease. We aim to describe our local experience with this treatment modality. |
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Material and Method All consecutive CTEPH patients who underwent PEA at our single tertiary cardiac institution from Jun 2015 to Dec 2018 were included. Baseline clinical characteristics and procedure details were collected. Efficacy outcomes studied included reduction in pulmonary pressures and resistance and improvements in functional status. Safety outcomes studied included peri-operative complications and mortality. |
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Result(s) A total of 16 patients (mean age 54.8 ± 9.9 years; 6 males) underwent PEA. 2 of the 4 patients (25%) from the initial series passed away in-hospital after the PEA due to right heart failure. The NHCS CTEPH team subsequently went for a team HMDP at the Royal Papworth Hospital in UK. There were no subsequent mortalities in the last consecutive 12 patients. One patient required temporary ECMO support for reperfusion lung injury but was successfully weaned off. Seven incidental cases of SDH were noted on routine CT Brain scan post PEA (1 required burrhole drainage, the rest were conservatively treated). In the remaining 14 patients, NYHA functional class improved in all to NYHA I-II at 3 to 6 months (p=0.003), and this improvement was sustained in the majority at 1 to 2 years of follow-up (p=0.011). There was significant reduction in pulmonary vascular resistance from 11.68±5.38 Woods pre-treatment to 4.06±3.68 Woods (p<0.001) post-treatment, as well as in mean pulmonary artery pressure from 49.2±7.07mmHg to 30.5±16.9mmHg post-treatment (p<0.001). |
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Conclusion PEA is a complex surgery that requires both good surgical technique as well as a comprehensive multi-disciplinary team care approach. Beyond the initial learning curve and with greater experience, the team has since achieved consistently improved outcomes. |