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Risk factors for pulmonary thromboendarterectomy.

Publication ,  Conference
Daily, PO; Dembitsky, WP; Iversen, S; Moser, KM; Auger, W
Published in: J Thorac Cardiovasc Surg
April 1990

Pulmonary thromboendarterectomy is being performed with increasing frequency for incapacitating pulmonary hypertension caused by chronic large-vessel pulmonary embolism. However, patient-related risk factors and procedural complications associated with morbidity and mortality have not been fully defined. From Oct. 1, 1984, to April 10, 1989, we performed pulmonary thromboendarterectomy using deep hypothermia and circulatory arrest in 127 consecutive patients (62.2% male, mean age 50 +/- 16 [standard deviation], range 20 to 82 years) in whom the exposure and dissection of the pulmonary arteries and methods for myocardial protection have been standardized. End points for univariate and multivariate analyses of risk factors were reperfusion pulmonary edema leading to respiratory insufficiency as defined by ventilator dependency (greater than or equal to 5 days) (31.5%, 39/124) and hospital mortality (12.6%, 16/127). Multivariate analyses showed that ascites and need for 4 units of blood or more predicted ventilator dependency (p less than 0.03). Increased cardiopulmonary bypass times predicted both end points (p less than 0.03 to less than 0.0001), and failure to achieve at least a 50% reduction in pulmonary vascular resistance strongly predicted hospital death (p less than 0.0001). However, other factors that exhibited trends for association with one of the end points may prove important with a larger sample size. A hospital mortality rate of 12.6% for pulmonary thromboendarterectomy is acceptable when compared with approximately 25% for heart-lung transplantation, which is the only therapeutic alternative. Increased ventilator dependency and hospital mortality can be anticipated with longer cardiopulmonary bypass times and inadequate reduction of pulmonary vascular resistance.

Duke Scholars

Published In

J Thorac Cardiovasc Surg

ISSN

0022-5223

Publication Date

April 1990

Volume

99

Issue

4

Start / End Page

670 / 678

Location

United States

Related Subject Headings

  • Risk Factors
  • Respiratory System
  • Respiration, Artificial
  • Pulmonary Embolism
  • Pulmonary Circulation
  • Pulmonary Artery
  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans
 

Citation

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Daily, P. O., Dembitsky, W. P., Iversen, S., Moser, K. M., & Auger, W. (1990). Risk factors for pulmonary thromboendarterectomy. In J Thorac Cardiovasc Surg (Vol. 99, pp. 670–678). United States.
Daily, P. O., W. P. Dembitsky, S. Iversen, K. M. Moser, and W. Auger. “Risk factors for pulmonary thromboendarterectomy.” In J Thorac Cardiovasc Surg, 99:670–78, 1990.
Daily PO, Dembitsky WP, Iversen S, Moser KM, Auger W. Risk factors for pulmonary thromboendarterectomy. In: J Thorac Cardiovasc Surg. 1990. p. 670–8.
Daily, P. O., et al. “Risk factors for pulmonary thromboendarterectomy.J Thorac Cardiovasc Surg, vol. 99, no. 4, 1990, pp. 670–78.
Daily PO, Dembitsky WP, Iversen S, Moser KM, Auger W. Risk factors for pulmonary thromboendarterectomy. J Thorac Cardiovasc Surg. 1990. p. 670–678.
Journal cover image

Published In

J Thorac Cardiovasc Surg

ISSN

0022-5223

Publication Date

April 1990

Volume

99

Issue

4

Start / End Page

670 / 678

Location

United States

Related Subject Headings

  • Risk Factors
  • Respiratory System
  • Respiration, Artificial
  • Pulmonary Embolism
  • Pulmonary Circulation
  • Pulmonary Artery
  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans