ABSTRACTS
Abstracts of the Netherlands Society of Thoracic Surgery (NvT)
Sessions
21-22 April 2005, Hotel Okura, Amsterdam VOORDRACHTEN NVT
09.00 - 09.15 uur
TELEMETRICALLY ADJUSTABLE PULMONARY ARTERY BAND IN PATIENTS WITH CONGENITAL HEART DISEASE N. Sekarski S. Di Bernardo, P. Fridez, M. Hurni, LK von Segesser, El Meijboom Pediatric Cardiology, Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudoise, Lausanne, Switzerland Introduction: Pulmonary artery banding(PAB) is used in pts with complex congenital heart disease(CHD) in which pulmonary blood flow needs to be limited and in patients with transposition of the great arteries(TGA), requiring retraining before arterial switching. A telemetrically operated, adjustable(A) PAB yields promising results in these pts.
Methods: The APAB was implanted in 16 pts (3 days - 39 mnths), weight of 2.5 - 9.2 kg (median 3.86 kg). Diagnosis included multiple ventricular septal defects(VSD) with arch hypoplasia/interruption, arch hypoplasia with aortic stenosis, atrioventricular septal defect, double outlet right ventricle, TGA and univentricular heart. Results: Initial closure ranged between 5 and 98% depending on pathology, mean gradient 33 mmHg (median 29.5 mmHg, range 8 70 mmHg). Adjustments of the APAB on average 6x per patient (range 1-12), 95 % of the adjustments were performed in ICU, based on saturations (5 year follow-up (mean 7 yrs): one patient (2.3%) died suddenly after 6 years; one patient underwent re-AVR 4 years later because of endocarditis and echocardiography at follow-up revealed mild aortic insufficiency in 3 patients. There were no other valve-related events in the whole group.
Conclusion AVR using a Freestyle stentless bioprothesis in patients younger than 50 years yields excellent short-term results. After 7 years, freedom from valve-related events remains very promising.
VOORDRACHTEN NVT
09.45 - 10.00 uur
BRIDGE TO TRANSPLANTATION, A 12 YEAR EXPERIENCE JR Lahgor, N de Jonge, H Wesenhagen, B Rodermans, E Sukkel, A Oosterom, C Klopping, H Kirkels, Hart Long Centrum UMC Utrecht Introduction. Bridge to transplantation (BTT) using various types of implantable ventricular assist devices (VAD's) has been widely accepted as a method to support end-stage heart failure patients (pts) with imminent risk of death until their heart transplantation (HTx). We describe a 12 years experience of this method. Methods. Since 1993 66 VAD's of 3 different types have been implanted as a BTT. The used VAD's were HeartMate LVAS 51(IP 33, VE 9, XVE 9), Thoratec VAD 11 and Novacor 4. Since 1999 over 70% of pts on a VAD were discharged from the hospital awaiting HTx. Results. The majority of pts were male (57), the mean age 38 + 13 years. The mean duration of support was 186 * 130 days with a perioperative survival of 86.4% and a survival until HTx of 80.3%. Major complications were thrombo-embolic (TE) events, right ventricular failure (RVF), infections and mechanical failure. TE rate was 9.8% in the HeartMate device (5 pts), 18% in the Thoratec device (2 pts) and 75% in the Novacor device (3 pts). RVF occurred in 15 pts (28%), 5 needed mechanical right ventricular support. Infections were driveline related In 15 pts (27%) and pocket related in 7 (13%). Six patients (13%) had an episode of septicemia of unknown origin. Mechanical failure consisting of inflow valve insufficiency was observed in 5 HeartMate VE pts.
Conclusion. Despite some major complications BTT provides excellent survival until transplantation in a group of HTx-candidates with Imminent risk of death. Focus on complication reduction is needed.
Conclusions: Blood DC levels in end-stage HF are altered in relation to etiology of cardiac disease. Whole blood DC characterisation may lead to new insights into the pathophysiology and progression of IDCM.
Ncthrlands Heart Journal, Volume 13, Number 5, May 2005
21
VOORDRACHTEN NVT
VOORDRACHTEN
NVT
OgnOO
-
09.15
09.15
uur
uur
TELEMETRICALLY ADJUSTABLE PULMONARY ARTERY BAND IN PATIENTS WITH CONGENITAL HEART DISEASE N. Sekarskl S. Di Bemardo, P. Fridez, M. Humi, LK von Segesser, El MeittQQm, Pediatric Cardiology, Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudoise, Lausanne, Switzerland
Introductfon: Pulmonary artery banding(PAB) is used In pts with complex congenital heart disease(CHD) in which pulmonary blood flow needs to be limited and in patients with transposition of the great arteries(TGA), requiring retraining before arterial switching. A telemetrically operated, adjustable(A) PAB yields promising results in these pts.
Methods: The APAB was Implanted in 16 pts (3 days - 39 mnths), weight of 2.5 - 9.2 kg (median 3.86 kg). Diagnosis included multiple ventricular septal defects(VSD) with arch hypoplasia/interruption, arch hypoplasia with aortic stenosis, atrioventricular septal defect, double outlet right ventricle, TGA and univentricular heart. Results: Initial closure ranged between 5 and 98% depending on pathology, mean gradient 33 mmHg (median 29.5 mmHg, range 8 70 mmHg). Adjustments of the APAB on average 6x per patient (range 1-12), 95 % of the adjustments were performed in ICU, based on saturations (6mmol/1). 3 adjustments were performed on an outpatient base to ameliorate increasing cyanosis, within 4 mnths of implantation. Explantation was performed at complete repair in 7pts, without difficulty, no reconstruction of the pulmonary artery was required. Three deaths were not related to the APAB. Two complications occurred which could be resolved without surgical
intervention. Conclusions: Telemetrically adjustable PAB is an accurate, dependable means of limiting pulmonary blood flow . It allows for a progressive and flexible approach in pts with complex heart lesions without a need for repetitive surgery to adjust a banding.
VOORDRACHTEN NVT
VOORDRACHTEN
NVT
09,30
09.30
-
09AS
09.45
uur
uur
ASSOCIATION OF BLOOD DENDRITC CELL LEVELS AND PHENOTYPE WITH ETIOLOGY OF HUMAN END-STAGE HEART FAILURE: IMPLICATIONS FOR IDIOPATHIC DILATED CARDIOMYOPATHY A LMB Vaessen , AHMM Balkc, JJM Takkenberga, W Welma and AJJC Bogersa Departments of 'Cardlothoraclc Surgery, bInternal Medlcine and cCardio/ogy. Erasmus MC, Rotterdam, The Netherlands.
Introductlon: Dendritic cells (DCs) are antigen presenting cells involved in the maintenance of experimentally induced heart failure (HF). In order to dissect a role for human DCs In cardiomyopathies of different origins, we examined blood myeloid (mDC) and plasmacytoid (pDC) levels and phenotype according to HF symptoms and etiology. Methods: Absolute numbers of mDCs and pDCs in 12 New York Heart Association (NYHA) class 1-II patients and 28 NYHA III-IV HF patients with coronary artery disease (CAD), hypertrophic (HCM) or idiopathic dilated cardiomyopathy (IDCM) and other causes of cardiac disease were compared with 18 healthy controls, by whole blood flow cytometry. DC subsets were further analyzed for maturation marker CD83 and lymphoid homing chemokine receptor CCR7 expression. Results: Patients with NYHA III-IV HF exhibited comparable DC levels with NYHA I-II patients and controls. Within the NYHA III-IV group, total circulating DC levels in IDCM patients were higher compared to patients with CAD, HCM or other underlying cardiac disease (P < 0.001). This was due to a significant increase of mDCs (P < 0.0001) and to a lesser extent of pDCs (P < 0.05), independent of left ventricular ejection fraction. Cell surface CD83 and CCR7 expression was enhanced only on mDCs, but not pDCs from IDCM patients (P < 0.05), compared to patients with other causes of cardiac disease.
Conclusions: Blood DC levels in end-stage HF are altered in relation to etiology of cardiac disease. Whole blood DC characterisation may lead to new insights into the pathophysiology and progression of IDCM.
VOORDRACHTEN NVT
VOORDRACHTEN
NVT
09,15
-
09,30 09.30
uur
uur
AORTIC VALVE REPLACEMENT WITH FREESTYLE IN PATIENTS LESS THAN 50 YEARS S.JLaiezaJ, J. Braun, M.G. Hazekamp, P.H. Schoof, A. Tjon, A. de Weger, R.J.M. Klautz, M.I.M. Versteegh, R.A.E. Dion Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. Introduction A stentless bioprosthesis is expected to be more durable than a stented one. Therefore, we have used it in younger patients when the choice for a mechanical valve was less appropriate. We analysed the early outcome and mid-term follow-up of these patients. Methods From 1996 till 2004, 47 patients under the age of 50 years underwent aortic valve replacement (AVR) by means of Freestyle. Mean age was 30.0 years (10.2-48.3 yrs). Etiology was rheumatic in 17 patients, congenital in 15, Marfan in 6, endocarditis in 5, failure of previous prosthesis in 3 and unknown in 1. Twenty-one patients (450/o) had undergone previous cardiac surgery. Mean Freestyle size was 25. Implantation technique was a root replacement in 26 patients (55%), subcoronary in 17 (36%) and mini-root in 4. Twentyone patients had concomitant surgery. Results There was no hospital mortality. Mean follow-up was 52.5 months (0.2-105.3). Twenty-five patients (53%) have >5 year follow-up (mean 7 yrs): one patient (2.3%) died suddenly after 6 years; one patient underwent re-AVR 4 years later because of endocarditis and echocardiography at follow-up revealed mild aortic insufficiency in 3 patients. There were no other valve-related events in the whole group.
Conclusion AVR using a Freestyle stentless bioprothesis in patients younger than 50 years yields excellent short-term results. After 7 years, freedom from valve-related events remains very promising.
VOORDRACHTEN NVT
VOORDRACHTEN
NVT
09,45
-
10-00
uur
BRIDGE TO TRANSPLANTATION, A 12 YEAR EXPERIENCE JRLbQr, N de Jonge, H Wesenhagen, B Rodermans, E Sukkel, A Oosterom, C Klkpping, H Kirkels,IHart Long Centrum UMC Utrecht
Introduction. Bridge to transplantation (BTT) using various types of implantable ventricular assist devices (VAD's) has been widely accepted as a method to support end-stage heart failure patients (pts) with imminent risk of death until their heart transplantation (HTx). We describe a 12 years experience of this method. Methods. Since 1993 66 VAD's of 3 different types have been implanted as a BTT. The used VAD's were HeartMate LVAS 51(IP 33, VE 9, XVE 9), Thoratec VAD 11 and Novacor 4. Since 1999 over 70%/O of pts on a VAD were discharged from the hospital awaiting HTx. Reults. The majority of pts were male (57), the mean age 38 ± 13 years. The mean duration of support was 186 t 130 days with a perioperative survival of 86.4%/ and a survival until HTx of 80.30/o. Major complications were thrombo-embolic (TE) events, right ventricular failure (RVF), infections and mechanical failure. TE rate was 9.8% in the HeartMate device (5 pts), 18% in the Thoratec device (2 pts) and 75%O In the Novacor device (3 pts). RVF occurred in 15 pts (28%), 5 needed mechanical right ventricular support. Infections were driveline related in 15 pts (27%) and pocket related in 7 (13%). Six patients (13%) had an episode of septicemia of unknown origin. Mechanical failure consisting of inflow valve insufficiency was observed in 5 HeartMate VE pts.
Conclusion. Despite some major complications BTT provides excellent survival until transplantation in a group of HTx-candidates with imminent risk of death. Focus on complication reduction is needed.
Abstracts
Sessions Posters VOORDRACHTEN NVT
10.00 - 10.15 uur
PULMONARY ENDARTERECTOMY: A SINGLE INSTITUTION'S EXPERIENCE IN 46 CASES. A Yilmaz. RH Heijmen, R Snijder, WJ Morshuis, HWM Plokker. St Antonius Hospital, Nleuwegein
Introduction:
Chronic thromboembolic pulmonary hypertension, with gradually right ventricular failure, is a relatively rare but a progressive disease with eventually a fatal outcome. Pulmonary endarterectomy (PE) may offer an improved functional status and longer life expectancy for the majority of patients. Methods: A retrospective analysis was performed of all patients who underwent PE at our institution, using extracorporeal circulation (ECC) under deep hypothermia with intermittent circulatory arrest.
Results: Since December 1999, 46 patients underwent PE at our institution. Demographic data and operative results are depicted in the Table. The median interval between pulmonary embolism and surgical intervention was 31 months. In all patients PE was successfully performed. Overall, endarterectomy required 3 episodes of 20-minute circulatory arrest (59 * 23 minutes). In 8 patients (17%) an interatrial communication was fuund and subsequently dosed. Hospital mortality was 11% (5/46). No neurological events were noted postoperatively and the mean pulmonary artery pressure was reduced signiflcantly (p
Abstracts of the Netherlands Society of Thoracic Surgery (NvT)
Sessions
21-22 April 2005, Hotel Okura, Amsterdam VOORDRACHTEN NVT
09.00 - 09.15 uur
TELEMETRICALLY ADJUSTABLE PULMONARY ARTERY BAND IN PATIENTS WITH CONGENITAL HEART DISEASE N. Sekarski S. Di Bernardo, P. Fridez, M. Hurni, LK von Segesser, El Meijboom Pediatric Cardiology, Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudoise, Lausanne, Switzerland Introduction: Pulmonary artery banding(PAB) is used in pts with complex congenital heart disease(CHD) in which pulmonary blood flow needs to be limited and in patients with transposition of the great arteries(TGA), requiring retraining before arterial switching. A telemetrically operated, adjustable(A) PAB yields promising results in these pts.
Methods: The APAB was implanted in 16 pts (3 days - 39 mnths), weight of 2.5 - 9.2 kg (median 3.86 kg). Diagnosis included multiple ventricular septal defects(VSD) with arch hypoplasia/interruption, arch hypoplasia with aortic stenosis, atrioventricular septal defect, double outlet right ventricle, TGA and univentricular heart. Results: Initial closure ranged between 5 and 98% depending on pathology, mean gradient 33 mmHg (median 29.5 mmHg, range 8 70 mmHg). Adjustments of the APAB on average 6x per patient (range 1-12), 95 % of the adjustments were performed in ICU, based on saturations (5 year follow-up (mean 7 yrs): one patient (2.3%) died suddenly after 6 years; one patient underwent re-AVR 4 years later because of endocarditis and echocardiography at follow-up revealed mild aortic insufficiency in 3 patients. There were no other valve-related events in the whole group.
Conclusion AVR using a Freestyle stentless bioprothesis in patients younger than 50 years yields excellent short-term results. After 7 years, freedom from valve-related events remains very promising.
VOORDRACHTEN NVT
09.45 - 10.00 uur
BRIDGE TO TRANSPLANTATION, A 12 YEAR EXPERIENCE JR Lahgor, N de Jonge, H Wesenhagen, B Rodermans, E Sukkel, A Oosterom, C Klopping, H Kirkels, Hart Long Centrum UMC Utrecht Introduction. Bridge to transplantation (BTT) using various types of implantable ventricular assist devices (VAD's) has been widely accepted as a method to support end-stage heart failure patients (pts) with imminent risk of death until their heart transplantation (HTx). We describe a 12 years experience of this method. Methods. Since 1993 66 VAD's of 3 different types have been implanted as a BTT. The used VAD's were HeartMate LVAS 51(IP 33, VE 9, XVE 9), Thoratec VAD 11 and Novacor 4. Since 1999 over 70% of pts on a VAD were discharged from the hospital awaiting HTx. Results. The majority of pts were male (57), the mean age 38 + 13 years. The mean duration of support was 186 * 130 days with a perioperative survival of 86.4% and a survival until HTx of 80.3%. Major complications were thrombo-embolic (TE) events, right ventricular failure (RVF), infections and mechanical failure. TE rate was 9.8% in the HeartMate device (5 pts), 18% in the Thoratec device (2 pts) and 75% in the Novacor device (3 pts). RVF occurred in 15 pts (28%), 5 needed mechanical right ventricular support. Infections were driveline related In 15 pts (27%) and pocket related in 7 (13%). Six patients (13%) had an episode of septicemia of unknown origin. Mechanical failure consisting of inflow valve insufficiency was observed in 5 HeartMate VE pts.
Conclusion. Despite some major complications BTT provides excellent survival until transplantation in a group of HTx-candidates with Imminent risk of death. Focus on complication reduction is needed.
Conclusions: Blood DC levels in end-stage HF are altered in relation to etiology of cardiac disease. Whole blood DC characterisation may lead to new insights into the pathophysiology and progression of IDCM.
Ncthrlands Heart Journal, Volume 13, Number 5, May 2005
21
VOORDRACHTEN NVT
VOORDRACHTEN
NVT
OgnOO
-
09.15
09.15
uur
uur
TELEMETRICALLY ADJUSTABLE PULMONARY ARTERY BAND IN PATIENTS WITH CONGENITAL HEART DISEASE N. Sekarskl S. Di Bemardo, P. Fridez, M. Humi, LK von Segesser, El MeittQQm, Pediatric Cardiology, Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudoise, Lausanne, Switzerland
Introductfon: Pulmonary artery banding(PAB) is used In pts with complex congenital heart disease(CHD) in which pulmonary blood flow needs to be limited and in patients with transposition of the great arteries(TGA), requiring retraining before arterial switching. A telemetrically operated, adjustable(A) PAB yields promising results in these pts.
Methods: The APAB was Implanted in 16 pts (3 days - 39 mnths), weight of 2.5 - 9.2 kg (median 3.86 kg). Diagnosis included multiple ventricular septal defects(VSD) with arch hypoplasia/interruption, arch hypoplasia with aortic stenosis, atrioventricular septal defect, double outlet right ventricle, TGA and univentricular heart. Results: Initial closure ranged between 5 and 98% depending on pathology, mean gradient 33 mmHg (median 29.5 mmHg, range 8 70 mmHg). Adjustments of the APAB on average 6x per patient (range 1-12), 95 % of the adjustments were performed in ICU, based on saturations (6mmol/1). 3 adjustments were performed on an outpatient base to ameliorate increasing cyanosis, within 4 mnths of implantation. Explantation was performed at complete repair in 7pts, without difficulty, no reconstruction of the pulmonary artery was required. Three deaths were not related to the APAB. Two complications occurred which could be resolved without surgical
intervention. Conclusions: Telemetrically adjustable PAB is an accurate, dependable means of limiting pulmonary blood flow . It allows for a progressive and flexible approach in pts with complex heart lesions without a need for repetitive surgery to adjust a banding.
VOORDRACHTEN NVT
VOORDRACHTEN
NVT
09,30
09.30
-
09AS
09.45
uur
uur
ASSOCIATION OF BLOOD DENDRITC CELL LEVELS AND PHENOTYPE WITH ETIOLOGY OF HUMAN END-STAGE HEART FAILURE: IMPLICATIONS FOR IDIOPATHIC DILATED CARDIOMYOPATHY A LMB Vaessen , AHMM Balkc, JJM Takkenberga, W Welma and AJJC Bogersa Departments of 'Cardlothoraclc Surgery, bInternal Medlcine and cCardio/ogy. Erasmus MC, Rotterdam, The Netherlands.
Introductlon: Dendritic cells (DCs) are antigen presenting cells involved in the maintenance of experimentally induced heart failure (HF). In order to dissect a role for human DCs In cardiomyopathies of different origins, we examined blood myeloid (mDC) and plasmacytoid (pDC) levels and phenotype according to HF symptoms and etiology. Methods: Absolute numbers of mDCs and pDCs in 12 New York Heart Association (NYHA) class 1-II patients and 28 NYHA III-IV HF patients with coronary artery disease (CAD), hypertrophic (HCM) or idiopathic dilated cardiomyopathy (IDCM) and other causes of cardiac disease were compared with 18 healthy controls, by whole blood flow cytometry. DC subsets were further analyzed for maturation marker CD83 and lymphoid homing chemokine receptor CCR7 expression. Results: Patients with NYHA III-IV HF exhibited comparable DC levels with NYHA I-II patients and controls. Within the NYHA III-IV group, total circulating DC levels in IDCM patients were higher compared to patients with CAD, HCM or other underlying cardiac disease (P < 0.001). This was due to a significant increase of mDCs (P < 0.0001) and to a lesser extent of pDCs (P < 0.05), independent of left ventricular ejection fraction. Cell surface CD83 and CCR7 expression was enhanced only on mDCs, but not pDCs from IDCM patients (P < 0.05), compared to patients with other causes of cardiac disease.
Conclusions: Blood DC levels in end-stage HF are altered in relation to etiology of cardiac disease. Whole blood DC characterisation may lead to new insights into the pathophysiology and progression of IDCM.
VOORDRACHTEN NVT
VOORDRACHTEN
NVT
09,15
-
09,30 09.30
uur
uur
AORTIC VALVE REPLACEMENT WITH FREESTYLE IN PATIENTS LESS THAN 50 YEARS S.JLaiezaJ, J. Braun, M.G. Hazekamp, P.H. Schoof, A. Tjon, A. de Weger, R.J.M. Klautz, M.I.M. Versteegh, R.A.E. Dion Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. Introduction A stentless bioprosthesis is expected to be more durable than a stented one. Therefore, we have used it in younger patients when the choice for a mechanical valve was less appropriate. We analysed the early outcome and mid-term follow-up of these patients. Methods From 1996 till 2004, 47 patients under the age of 50 years underwent aortic valve replacement (AVR) by means of Freestyle. Mean age was 30.0 years (10.2-48.3 yrs). Etiology was rheumatic in 17 patients, congenital in 15, Marfan in 6, endocarditis in 5, failure of previous prosthesis in 3 and unknown in 1. Twenty-one patients (450/o) had undergone previous cardiac surgery. Mean Freestyle size was 25. Implantation technique was a root replacement in 26 patients (55%), subcoronary in 17 (36%) and mini-root in 4. Twentyone patients had concomitant surgery. Results There was no hospital mortality. Mean follow-up was 52.5 months (0.2-105.3). Twenty-five patients (53%) have >5 year follow-up (mean 7 yrs): one patient (2.3%) died suddenly after 6 years; one patient underwent re-AVR 4 years later because of endocarditis and echocardiography at follow-up revealed mild aortic insufficiency in 3 patients. There were no other valve-related events in the whole group.
Conclusion AVR using a Freestyle stentless bioprothesis in patients younger than 50 years yields excellent short-term results. After 7 years, freedom from valve-related events remains very promising.
VOORDRACHTEN NVT
VOORDRACHTEN
NVT
09,45
-
10-00
uur
BRIDGE TO TRANSPLANTATION, A 12 YEAR EXPERIENCE JRLbQr, N de Jonge, H Wesenhagen, B Rodermans, E Sukkel, A Oosterom, C Klkpping, H Kirkels,IHart Long Centrum UMC Utrecht
Introduction. Bridge to transplantation (BTT) using various types of implantable ventricular assist devices (VAD's) has been widely accepted as a method to support end-stage heart failure patients (pts) with imminent risk of death until their heart transplantation (HTx). We describe a 12 years experience of this method. Methods. Since 1993 66 VAD's of 3 different types have been implanted as a BTT. The used VAD's were HeartMate LVAS 51(IP 33, VE 9, XVE 9), Thoratec VAD 11 and Novacor 4. Since 1999 over 70%/O of pts on a VAD were discharged from the hospital awaiting HTx. Reults. The majority of pts were male (57), the mean age 38 ± 13 years. The mean duration of support was 186 t 130 days with a perioperative survival of 86.4%/ and a survival until HTx of 80.30/o. Major complications were thrombo-embolic (TE) events, right ventricular failure (RVF), infections and mechanical failure. TE rate was 9.8% in the HeartMate device (5 pts), 18% in the Thoratec device (2 pts) and 75%O In the Novacor device (3 pts). RVF occurred in 15 pts (28%), 5 needed mechanical right ventricular support. Infections were driveline related in 15 pts (27%) and pocket related in 7 (13%). Six patients (13%) had an episode of septicemia of unknown origin. Mechanical failure consisting of inflow valve insufficiency was observed in 5 HeartMate VE pts.
Conclusion. Despite some major complications BTT provides excellent survival until transplantation in a group of HTx-candidates with imminent risk of death. Focus on complication reduction is needed.
Abstracts
Sessions Posters VOORDRACHTEN NVT
10.00 - 10.15 uur
PULMONARY ENDARTERECTOMY: A SINGLE INSTITUTION'S EXPERIENCE IN 46 CASES. A Yilmaz. RH Heijmen, R Snijder, WJ Morshuis, HWM Plokker. St Antonius Hospital, Nleuwegein
Introduction:
Chronic thromboembolic pulmonary hypertension, with gradually right ventricular failure, is a relatively rare but a progressive disease with eventually a fatal outcome. Pulmonary endarterectomy (PE) may offer an improved functional status and longer life expectancy for the majority of patients. Methods: A retrospective analysis was performed of all patients who underwent PE at our institution, using extracorporeal circulation (ECC) under deep hypothermia with intermittent circulatory arrest.
Results: Since December 1999, 46 patients underwent PE at our institution. Demographic data and operative results are depicted in the Table. The median interval between pulmonary embolism and surgical intervention was 31 months. In all patients PE was successfully performed. Overall, endarterectomy required 3 episodes of 20-minute circulatory arrest (59 * 23 minutes). In 8 patients (17%) an interatrial communication was fuund and subsequently dosed. Hospital mortality was 11% (5/46). No neurological events were noted postoperatively and the mean pulmonary artery pressure was reduced signiflcantly (p
