Pulmonary embolectomy and thromboendarterectomy in seven cases

Amac: Bu calismanin amaci, akut pulmoner emboli (APE) ve kronik tromboembolik pulmoner hipertansiyon (KTPHT) olgularinin cerrahi ile belirgin olarak duzeldiklerini ongoren kanita dayali veriler temelinde cerrahi sonrasi seyir ile ilgili belirsizligi azaltmak ve bu olgularda cerrahi tedavi seceneklerini dikkate alan doktorlari cesaretlendirmektir. Ca­lis­ma­ pla­ni:­Bu gozlemsel ve geriye donuk gerceklestirilen calismaya Şubat 2009 ile Ekim 2010 tarihleri arasinda, APE ve KTPHT tanisi ile ameliyat edilen yedi olgu (3 erkek, 4 kadin; ort yas 43.8±18.5 yil; dagilim 25-73 yil) dahil edildi. Hastalarin ameliyat oncesi ve sonrasi ortalama pulmoner arter basinci (mPAP), New York Heart Association (NYHA) fonksiyonel sinifi, yogun bakim unitesi (YBU) ve hastanede kalis suresi, demografik, klinik ve ameliyat ozellikleri kaydedildi. Olgu sayisinin yetersizliginden dolayi istatistiksel analizler, parametrik olmayan testler ile yapildi. Gruplarin karsilastirilmasinda Wilcoxon testi kullanildi. Bul gu lar: Cerrahi sonrasinda butun hastalarda mPAP’da 20 mmHg (dagilim 5-53) dusus saglandi ve altinci olgu haric tum olgularin mPAP’lari, 30 mmHg’nin altina cekildi. Ameliyat oncesi ve sonrasi mPAP’lari, sirasiyla 43 mmHg (dagilim 33-68) ve 23 mmHg (dagilim 15-37) idi. Bu durumda cerrahi sonrasinda anlamli bir dusus elde edildi (z=-2.36; p=0.018). Buna ilaveten, cerrahi sonrasinda hastanin NYHA sinifindaki iyilesmesi 1 (dagilim 1-3) birimdi. Hastalarin ameliyat oncesi ve sonrasi NYHA siniflari sirasiyla III (II-III) ve II (I-II) idi. Ameliyat sonrasi NYHA sinifindaki dusus ile birlikte cerrahinin iyilestirme uzerine etkisi anlamliydi (z=2.26; p=0.024). Yogun bakim unitesi ve hastanede ortalama kalis sureleri, sirasiyla uc (dagilim 2-14) ve 9.5 (dagilim 5-27) gundu. So­nuc:­Calisma bulgularimiza gore, ayrintili bir ameliyat oncesi degerlendirme ve uygun hasta secimi ile hekimler, cerrahi secenegin kararinda cekimser olmamali ve hastalarin yasam kalitesini artirmak icin caba harcamalidir. Anah tar soz cuk ler: Akut pulmoner emboli; kronik tromboembolik pulmoner hipertansiyon; fonksiyonel kapasite; ortalama pulmoner arter basinci; pulmoner tromboendarterektomi. 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 preand 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 preand 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.