Evaluation of hemodynamic changes by right heart catheterization after thromboendarctomy in Patients with chronic thromboembolism

Abstract

Chronic thromboembolic hypertension (CTEPH) is one of the most treatable causes of hypertensive pulmonary disease. The treatment of choice for CTEPH is surgical removal of organized thromboembolic material from the main pulmonary arteries by pulmonary thromboembolism (PEA). Due to the increase in the diagnosis of hypertensive pulmonary disease in the field of chronic pulmonary thromboembolism, and the expansion of the use of pulmonary thromboendarctomy in these patients and the results of studies in this case and the effect of surgical technique on improving clinical outcomes and patient outcomes In this regard, as well as the lack of a similar study in our region, so in the present study we aimed to evaluate hemodynamic changes with right heart catheterization after thromboendarcterectomy in patients with chronic thromboembolism. Methods: In this cross-sectional study, after the approval of the Ethics Committee of the Vice Chancellor for Research, Tabriz University of Medical Sciences, all patients who referred to the pulmonary hypertension clinic of Imam Reza Hospital during 2016-2020 to be diagnosed with pulmonary hypertension were diagnosed with Chronic embolism secondary topulmonary hypertension were included in the study. Hemodynamic evaluation of patients before and after thromboendarctomy was performed by right catheterization. All cases were recorded in the relevant checklist and study data were collected. Results In this cross-sectional study, 71 patients were included in the study. Of these, 35 (49.3%) were male and 36 (50.7%) were female. A total of 31 patients underwent PEA surgery. Postoperative complications occurred in 10 patients (32.3%). In-hospital mortality occurred for 1 patient (2 3.2) due to right ventricular failure and reperfusion injury. In 30 postoperative survivors, mean pulmonary arterial pressure decreased significantly from 47.6 ± 12 mm Hg before surgery to 29.7 ± 9.1 mmHg after surgery (p = 0.001). Pulmonary artery pressure was significantly higher in patients with Reperfusion injury (1292 ± 372 dynes.Sec-1.Cm-5) compared with patients without reperfusion injury (492 ± 339 dynes.Sec-1.Cm-5 mmHg)(P = 0.00). At one-year postoperative follow-up, acute embolism or recurrence of CTEPH was not observed in any of the patients. All patients were evaluated for progression in the NYHA class, of whom 28 (93%) were FCI and 2 (6%) were FCII. In addition, 6MWD level showed significant postoperative improvement (299 ± 113 m vs. 404 ± 60 m) (p = 0.01).