An association between ventricular function and vascular loading and outcomes was observed in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary thromboendarterectomy (PTE), according to study results published in the Annals of the American Thoracic Society.
Preoperative right heart catheterization and echocardiographic data as well as postoperative hemodynamics and clinical history were retrospectively reviewed from patients with CTEPH undergoing pulmonary thromboendarterectomy. Postoperative measurements were obtained at time of discharge from the intensive care unit (ICU). Pulmonary vascular compliance was calculated from pulmonary artery catheterization parameters.
None of the 37 consecutive patients with CTEPH undergoing pulmonary thromboendarterectomy died or had prolonged hemodynamic instability. Predictive models determined that both conventional and dynamic pre-PTE measures were predictive of post-PTE hemodynamics. Specifically, both pulmonary artery dynamics parameters and right ventricular functional measures were important in predicting postoperative changes. However, clinical outcomes such as ICU duration, need for inotropes, and length of stay were not included in this study. The authors noted that a larger study controlling for other factors such as operative complications and comorbidities is warranted.
“Dynamic measures of ventricular function and vascular loading, estimated via [end-systolic elastance], [pulmonary elastance] and [pulmonary vascular compliance] derived from clinical measures, were correlated with post-PTE [pulmonary artery systolic pressure], [pulmonary vascular resistance], and [total pulmonary resistance],” the study authors concluded.
Contijoch F, Wong D, Igata S, et al. Association between pre-operative dynamic measures of vascular load and post-operative hemodynamics in patients with chronic thromboembolic pulmonary hypertension after pulmonary thromboendarterectomy. Ann Am Thorac Soc. Published online November 3, 2020. doi:10.1513/AnnalsATS.202006-685RL