Tromboendarterectomía pulmonar: tratamiento de elección para la hipertensión pulmonar tromboembólica crónica / Pulmonary thromboendarterectomy is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension
Rev. am. med. respir
; 11(2): 74-83, jun. 2011. ilus, graf, tab
Article
em Es
| LILACS
| ID: lil-655639
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AR1.1
RESUMEN
La tromboendarterectomía pulmonar es la terapéutica de elección para pacientes con hipertensión pulmonar tromboembólica crónica. Objetivos:
Reportar la experiencia en tromboendarterectomía pulmonar a 18 años de seguimiento. Material yMétodos:
Se analizaron retrospectivamente 41 pacientes entre Noviembre 1992 y Agosto 2010.Criterios de inclusión presión arterial pulmonar media >30 mmHg y resistenciavascular pulmonar (RVP) >300 dinas/sg. cm-5. La angiografía pulmonar determinó la factibilidad quirúrgica. La supervivencia se calculó utilizando el método de Kaplan-Meier y para comparar 2 grupos log-rank test.Resultados:
El 44% de los pacientes estaban en clase funcional IV. Los cambios hemodinámicos posteriores a la tromboendarterectomía fueron significativos p <0.001. La PAPm 53 ± 2 a 29 ± 2 mmHg, la RVP 857 ± 65 a 245 ± 25 dinas/sg. cm-5 y el IC 2,3 ± 0,1a 3 ± 0,1. La mortalidad hospitalaria fue 15%, en CF II-III 4% y en CF IV 33% (p=0.01). La mortalidad alejada fue 11%. El 93% de los pacientes mejoró su clase funcional. La supervivencia global a 1, 2, 5, 10 años fue del 85%, 82%, 75% y 71% respectivamente.La supervivencia por clase funcional mostró diferencias significativas (p=0.02).Conclusión:
En nuestra experiencia la tromboendarterectomía pulmonar mostró beneficios en esta población de alto riesgo.ABSTRACT
Pulmonary thromboendarterectomy is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension. Objective:
To report our 18-years experience in pulmonary thromboendarterectomy. Material andMethods:
Forty one patients were analyzed between November/1992 andAugust/2010. Inclusion criteria mean pulmonary artery pressure (PAPm) >30 mmHg and pulmonary vascular resistance (PVR) >300 dinas/sec.cm-5. Pulmonary angiography determined the surgical feasibility. Survival was calculated using the Kaplan-Meiermethod and to compare the 2 groups log rank test.results:
Pulmonary thromboendarterectomy is the treatment of choice for patients with chronicthromboembolic pulmonary hypertension.Objective:
To report our 18-years experience in pulmonary thromboendarterectomy. Material andMethods:
Forty one patients were analyzed between November/1992 andAugust/2010. Inclusion criteria mean pulmonary artery pressure (PAPm) >30 mmHg and pulmonary vascular resistance (PVR) >300 dinas/sec.cm-5. Pulmonary angiography determined the surgical feasibility. Survival was calculated using the Kaplan-Meiermethod and to compare the 2 groups log rank test.Results:
Forty four percent of the patients were classified in class IV. The hemodynamic changesafter pulmonary thromboendarterectomy were significant (p < 0.001). PAPm 53 ± 2 vs. 29 ± 2 mm Hg, PVR 857 ± 65 vs. 245 ± 25 dinas/sec. cm-5 and CI 2.3 ± 0.1 vs. 3 ± 0.1. In-hospital mortality was 15%; in classes II - III was 4%, and in class IV 33% (p = 0.01). Late mortality was 12%. Ninety three percent of the patients improved their functional class. Overall survival at 1,2, 5 and 10 years was 85%, 82%, 75% and 71% respectively. Survival according to functional class showed significant differences (p = 0.02).Conclusion:
In our experience pulmonary thromboendarterectomy showed benefits even in thishigh risk population.Palavras-chave
Texto completo:
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Base de dados:
LILACS
Assunto principal:
Endarterectomia
/
Hipertensão Pulmonar
Idioma:
Es
Ano de publicação:
2011
Tipo de documento:
Article