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doi:10.22028/D291-38563
Titel: | Haemodynamic benefit of bridging use of bosentan prior to pulmonary endarterectomy |
VerfasserIn: | Kunihara, Takashi Wilkens, Heinrike Halank, Michael Held, Matthias Nomura, Ryota Igarashi, Takashi Sata, Fumihiro Schäfers, Hans-Joachim |
Sprache: | Englisch |
Titel: | European Journal of Cardio-Thoracic Surgery |
Bandnummer: | 60 |
Heft: | 4 |
Seiten: | 840-847 |
Verlag/Plattform: | Oxford University Press |
Erscheinungsjahr: | 2021 |
Freie Schlagwörter: | Chronic thromboembolic pulmonary hypertension Pulmonary endarterectomy Bosentan Haemodynamic improvement |
DDC-Sachgruppe: | 610 Medizin, Gesundheit |
Dokumenttyp: | Journalartikel / Zeitschriftenartikel |
Abstract: | OBJECTIVES Some patients present with excessive pulmonary hypertension (PH) prior to pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). This study was performed to evaluate the clinical role of pretreatment before PEA in CTEPH patients. METHODS A total of 370 patients with CTEPH undergoing first PEA between 2003 and 2017 were divided into those receiving pretreatment with bosentan (group B: n = 119) and those without targeted pretreatment for PH (group C: n = 251). After selecting patients given bosentan (2–8 months) and using propensity score matching, comparable patient cohorts (n = 23 each) were created from both groups. PEA was performed in the standard manner, and the median number of extracted segments was 14. RESULTS There were no significant differences in perioperative demographic characteristics or 30-day mortality (overall 5.7%) between the groups before and after matching. In patients with preoperative pulmonary vascular resistance (PVR) ≥800 dynes s/cm5, a significantly larger decrease in PVR was found in group B (78%) compared to group C (68%) (P = 0.033). There was no significant difference in late survival between the groups after matching. The frequency of residual/persistent PH (mean pulmonary artery pressure >25 mmHg) was lower in group B than in group C, although the difference was not significant (22% vs 39%, respectively, P = 0.200). Advanced age and longer cardiopulmonary bypass time were independent predictors of both 30-day mortality and residual/persistent PH (odds ratio: age, 1.053, 1.013, cardiopulmonary bypass time, 1.065, 1.010, respectively). CONCLUSIONS Preoperative treatment of CTEPH patients with bosentan for 2–8 months can improve post-PEA PVR without adverse clinical events in patients with a high preoperative PVR. A temporary bridging regime appears beneficial in selected patients prior to PEA. |
DOI der Erstveröffentlichung: | 10.1093/ejcts/ezab137 |
URL der Erstveröffentlichung: | https://doi.org/10.1093/ejcts/ezab137 |
Link zu diesem Datensatz: | urn:nbn:de:bsz:291--ds-385633 hdl:20.500.11880/34755 http://dx.doi.org/10.22028/D291-38563 |
ISSN: | 1873-734X 1010-7940 |
Datum des Eintrags: | 13-Dez-2022 |
Bezeichnung des in Beziehung stehenden Objekts: | Supplementary Material |
In Beziehung stehendes Objekt: | https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ejcts/60/4/10.1093_ejcts_ezab137/1/ezab137_supplementary_data.docx?Expires=1672992278&Signature=ka56vbTqMWUirbJPs4yjfjHQAYvDNXgzhQcSYVG~sWkphRSIty3hodqvlbyN47JMGYvTVvc~Jv~6aLyOxZuzjA1rMqwNbBM-xWqe64zk0WOXa-f2VazuH9xPpy~ifWg04pbHTfg-AWLAsOb0OWV4fZzBnHkmGHbSfK0Hg1I0IplSXoxL94zgKY~R6PrFVVN3YXRlD6LkkBQ-wfPekeUx92XcjGHttduIbJiy6m-oRqn92G3T9fJNyOtHB3tkyhOFFU-9L929zVhWX22EEnUY6GtFIzDtjiusr2acU8M1FBUogXRkm6vxPq5jqTdJGzUaUiTBWtL8ho4c2rxaoUe5pw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA |
Fakultät: | M - Medizinische Fakultät |
Fachrichtung: | M - Chirurgie M - Innere Medizin |
Professur: | M - Prof. Dr. Hans Joachim Schäfers M - Keiner Professur zugeordnet |
Sammlung: | SciDok - Der Wissenschaftsserver der Universität des Saarlandes |
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