Yıl: 2012 Cilt: 20 Sayı: 3 Sayfa Aralığı: 442 - 449 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Pulmonary embolectomy and thromboendarterectomy in seven cases

Öz:
Amaç: Bu çalışmanın amacı, akut pulmoner emboli (APE) ve kronik tromboembolik pulmoner hipertansiyon (KTPHT) olgularının cerrahi ile belirgin olarak düzeldiklerini öngören kanıta dayalı veriler temelinde cerrahi sonrası seyir ile ilgili belirsizliği azaltmak ve bu olgularda cerrahi tedavi seçeneklerini dikkate alan doktorları cesaretlendirmektir. Çalışma planı: Bu gözlemsel ve geriye dönük gerçekleştirilen çalışmaya Şubat 2009 ile Ekim 2010 tarihleri arasında, APE ve KTPHT tanısı ile ameliyat edilen yedi olgu (3 erkek, 4 kadın; ort yaş 43.8±18.5 yıl; dağılım 25-73 yıl) dahil edildi. Hastaların ameliyat öncesi ve sonrası ortalama pulmoner arter basıncı (mPAP), New York Heart Association (NYHA) fonksiyonel sınıfı, yoğun bakım ünitesi (YBÜ) ve hastanede kalış süresi, demografik, klinik ve ameliyat özellikleri kaydedildi. Olgu sayısının yetersizliğinden dolayı istatistiksel analizler, parametrik olmayan testler ile yapıldı. Grupların karşılaştırılmasında Wilcoxon testi kullanıldı. Bulgular: Cerrahi sonrasında bütün hastalarda mPAP’da 20 mmHg (dağılım 5-53) düşüş sağlandı ve altıncı olgu hariç tüm olguların mPAP’ları, 30 mmHg’nın altına çekildi. Ameliyat öncesi ve sonrası mPAP’ları, sırasıyla 43 mmHg (dağılım 33-68) ve 23 mmHg (dağılım 15-37) idi. Bu durumda cerrahi sonrasında anlamlı bir düşüş elde edildi (z=-2.36; p=0.018). Buna ilaveten, cerrahi sonrasında hastanın NYHA sınıfındaki iyileşmesi 1 (dağılım 1-3) birimdi. Hastaların ameliyat öncesi ve sonrası NYHA sınıfları sırasıyla III (II-III) ve II (I-II) idi. Ameliyat sonrası NYHA sınıfındaki düşüş ile birlikte cerrahinin iyileştirme üzerine etkisi anlamlıydı (z=- 2.26; p=0.024). Yoğun bakım ünitesi ve hastanede ortalama kalış süreleri, sırasıyla üç (dağılım 2-14) ve 9.5 (dağılım 5-27) gündü. Sonuç: Çalışma bulgularımıza göre, ayrıntılı bir ameliyat öncesi değerlendirme ve uygun hasta seçimi ile hekimler, cerrahi seçeneğin kararında çekimser olmamalı ve hastaların yaşam kalitesini artırmak için çaba harcamalıdır.
Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi Cerrahi

Yedi olguda pulmoner embolektomi ve tromboendarterekt

Öz:
Background: This study aims to reduce the uncertainity related to the prognosis after surgery of the acute pulmonary embolism (APE) and chronic thromboembolic pulmonary hypertension (CTPHT) patients, and to encourage physicians to consider surgical treatment options based on the evidence-based data which suggests that surgery offers the best chance for improvement in these patients. Methods: Between February 2009 and October 2010, seven cases (3 males, 4 females; mean age 43.8±18.5 years; range 25 to 73 years) who were operated on due to APE and CTPHT were included in this observational and retrospective study. The preand postoperative mean pulmonary artery pressure (mPAP), New York Heart Association (NYHA) functional class, and length of stay in the intensive care unit (ICU) and hospital along with the demographic, clinical and operational characteristics of the patients were recorded. Statistical analyses were performed using nonparametric tests due to the limited number of cases. Wilcoxon’s test was used to compare the groups. Results: The mPAP reduced by 20 mmHg (range 5-53) following surgery, and the mPAPs in all the patients, except for the sixth case, decreased below 30 mmHg. The pre- and postoperative mPAPs were 43 mmHg (range 33-68) and 23 mmHg (range 15-37), respectively. This indicated that a significant reduction occurred following surgery (z=-2.36; p=0.018). In addition, the NYHA functional class of the patients improved by one unit following surgery (range I-III). The patients pre- and postoperative NYHA classes were III (II-III) and II (I-II), respectively. The improvement after surgery was significant with a decline in the NYHA class (z=-2.26; p=0.024). The patients also averaged a stay of three days in the ICU (range 2-14) and 9.5 days (range 5-27) in the hospital. Conclusion: Our study results suggest that physicians should not be reluctant to choose the surgical option and should endeavor to improve the quality of life of their patients through a detailed preoperative assessment and proper patient selection.
Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi Cerrahi
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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  • 1. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER) Lancet 1999;353:1386-9.
  • 2. Doerge H, Schoendube FA, Voss M, Seipelt R, Messmer BJ. Surgical therapy of fulminant pulmonary embolism: early and late results. Thorac Cardiovasc Surg 1999;47:9-13.
  • 3. Meyer G, Tamisier D, Sors H, Stern M, Vouhé P, Makowski S, et al. Pulmonary embolectomy: a 20-year experience at one center. Ann Thorac Surg 1991;51:232-6.
  • 4. Yalamanchili K, Fleisher AG, Lehrman SG, Axelrod HI, Lafaro RJ, Sarabu MR, et al. Open pulmonary embolectomy for treatment of major pulmonary embolism. Ann Thorac Surg 2004;77:819-23.
  • 5. Pengo V, Lensing AW, Prins MH, Marchiori A, Davidson BL, Tiozzo F, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004;350:2257-64.
  • 6. Ribeiro A, Lindmarker P, Johnsson H, Juhlin-Dannfelt A, Jorfeldt L. Pulmonary embolism: one-year follow-up with echocardiography doppler and five-year survival analysis. Circulation 1999;99:1325-30.
  • 7. Riedel M, Stanek V, Widimsky J, Prerovsky I. Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. Chest 1982;81:151-8.
  • 8. Kunieda T, Nakanishi N, Satoh T, Kyotani S, Okano Y, Nagaya N. Prognoses of primary pulmonary hypertension and chronic majorvessel thromboembolic pulmonary hypertension determined from cumulative survival curves. Intern Med 1999;38:543-6.
  • 9. Matsuda H, Ogino H, Minatoya K, Sasaki H, Nakanishi N, Kyotani S, et al. Long-term recovery of exercise ability after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ann Thorac Surg 2006;82:1338-43.
  • 10. Saouti N, Morshuis WJ, Heijmen RH, Snijder RJ. Longterm outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a single institution experience. Eur J Cardiothorac Surg 2009;35:947-52.
  • 11. Hoeper MM, Mayer E, Simonneau G, Rubin LJ. Chronic thromboembolic pulmonary hypertension. C i r c u l a t i o n 2006;113:2011-20.
  • 12. Freed DH, Thomson BM, Berman M, Tsui SS, Dunning J, Sheares KK, et al. Survival after pulmonary thromboendarterectomy: effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg 2011;141:383-7.
  • 13. Skoro-Sajer N, Hack N, Sadushi-Koliçi R, Bonderman D, Jakowitsch J, Klepetko W, et al. Pulmonary vascular reactivity and prognosis in patients with chronic thromboembolic pulmonary hypertension: a pilot study. Circulation 2009;119:298-305.
  • 14. Thistlethwaite PA, Mo M, Madani MM, Deutsch R, Blanchard D, Kapelanski DP, et al. Operative classification of thromboembolic disease determines outcome after pulmonary endarterectomy. J Thorac Cardiovasc Surg 2002;124:1203-11.
  • 15. Jamieson SW, Kapelanski DP, Sakakibara N, Manecke GR, Thistlethwaite PA, Kerr KM, et al. Pulmonary endarterectomy: experience and lessons learned in 1,500 cases. Ann Thorac Surg 2003;76:1457-62.
  • 16. Klepetko W, Mayer E, Sandoval J, Trulock EP, Vachiery JL, Dartevelle P, et al. Interventional and surgical modalities of treatment for pulmonary arterial hypertension. J Am Coll Cardiol 2004;43:73S-80S.
  • 17. Freed DH, Thomson BM, Tsui SS, Dunning JJ, Sheares KK, Pepke-Zaba J, et al. Functional and haemodynamic outcome 1 year after pulmonary thromboendarterectomy. Eur J Cardiothorac Surg 2008;34:525-9.
  • 18. Suntharalingam J, Treacy CM, Doughty NJ, Goldsmith K, Soon E, Toshner MR, et al. Long-term use of sildenafil in inoperable chronic thromboembolic pulmonary hypertension. Chest 2008;134:229-36.
  • 19. Stoney WS. A short history of cardiac surgery. In: Stoney WS, editor. Pioneers of cardiac surgery. Nashville: Vanderbilt University Press; 2008. p. 1-60.
  • 20. Opinions regarding the diagnosis and management of venous thromboembolic disease. ACCP Consensus Committee on Pulmonary Embolism. Chest 1996;109:233-7.
  • 21. Opinions regarding the diagnosis and management of venous thromboembolic disease. ACCP Consensus Committee on Pulmonary Embolism. American College of Chest Physicians. Chest 1998;113:499-504.
  • 22. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003;58:470-83.
  • 23. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008;29:2276-315.
  • 24. Aklog L, Williams CS, Byrne JG, Goldhaber SZ. Acute pulmonary embolectomy: a contemporary approach. Circulation 2002;105:1416-9.
  • 25. Narayana Iyengar RM, Hegde D, Chattuparambil B, Gupta R, Patil L. Postoperative management of pulmonary endarterectomy and outcome. Ann Card Anaesth 2010;13:22-7.
  • 26. Ishida K, Masuda M, Tanaka H, Imamaki M, Katsumata M, Maruyama T, et al. Mid-term results of surgery for chronic thromboembolic pulmonary hypertension. Interact Cardiovasc Thorac Surg 2009;9:626-9.
APA HAZAN E, Şişli E, UĞURLU Ş, AKDENİZ B, Baris N, SİLİSTRELİ E (2012). Pulmonary embolectomy and thromboendarterectomy in seven cases. , 442 - 449.
Chicago HAZAN Eyüp,Şişli Emrah,UĞURLU Ş. Baran,AKDENİZ Bahri,Baris Nezihi,SİLİSTRELİ Erdem Pulmonary embolectomy and thromboendarterectomy in seven cases. (2012): 442 - 449.
MLA HAZAN Eyüp,Şişli Emrah,UĞURLU Ş. Baran,AKDENİZ Bahri,Baris Nezihi,SİLİSTRELİ Erdem Pulmonary embolectomy and thromboendarterectomy in seven cases. , 2012, ss.442 - 449.
AMA HAZAN E,Şişli E,UĞURLU Ş,AKDENİZ B,Baris N,SİLİSTRELİ E Pulmonary embolectomy and thromboendarterectomy in seven cases. . 2012; 442 - 449.
Vancouver HAZAN E,Şişli E,UĞURLU Ş,AKDENİZ B,Baris N,SİLİSTRELİ E Pulmonary embolectomy and thromboendarterectomy in seven cases. . 2012; 442 - 449.
IEEE HAZAN E,Şişli E,UĞURLU Ş,AKDENİZ B,Baris N,SİLİSTRELİ E "Pulmonary embolectomy and thromboendarterectomy in seven cases." , ss.442 - 449, 2012.
ISNAD HAZAN, Eyüp vd. "Pulmonary embolectomy and thromboendarterectomy in seven cases". (2012), 442-449.
APA HAZAN E, Şişli E, UĞURLU Ş, AKDENİZ B, Baris N, SİLİSTRELİ E (2012). Pulmonary embolectomy and thromboendarterectomy in seven cases. Türk Göğüs Kalp Damar Cerrahisi Dergisi, 20(3), 442 - 449.
Chicago HAZAN Eyüp,Şişli Emrah,UĞURLU Ş. Baran,AKDENİZ Bahri,Baris Nezihi,SİLİSTRELİ Erdem Pulmonary embolectomy and thromboendarterectomy in seven cases. Türk Göğüs Kalp Damar Cerrahisi Dergisi 20, no.3 (2012): 442 - 449.
MLA HAZAN Eyüp,Şişli Emrah,UĞURLU Ş. Baran,AKDENİZ Bahri,Baris Nezihi,SİLİSTRELİ Erdem Pulmonary embolectomy and thromboendarterectomy in seven cases. Türk Göğüs Kalp Damar Cerrahisi Dergisi, vol.20, no.3, 2012, ss.442 - 449.
AMA HAZAN E,Şişli E,UĞURLU Ş,AKDENİZ B,Baris N,SİLİSTRELİ E Pulmonary embolectomy and thromboendarterectomy in seven cases. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2012; 20(3): 442 - 449.
Vancouver HAZAN E,Şişli E,UĞURLU Ş,AKDENİZ B,Baris N,SİLİSTRELİ E Pulmonary embolectomy and thromboendarterectomy in seven cases. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2012; 20(3): 442 - 449.
IEEE HAZAN E,Şişli E,UĞURLU Ş,AKDENİZ B,Baris N,SİLİSTRELİ E "Pulmonary embolectomy and thromboendarterectomy in seven cases." Türk Göğüs Kalp Damar Cerrahisi Dergisi, 20, ss.442 - 449, 2012.
ISNAD HAZAN, Eyüp vd. "Pulmonary embolectomy and thromboendarterectomy in seven cases". Türk Göğüs Kalp Damar Cerrahisi Dergisi 20/3 (2012), 442-449.