JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (17) Citing Articles via Google Scholar Google Scholar Articles by Mares, P. Articles by Haider, W. Search for Related Content PubMed PubMed Citation Articles by Mares, P. Articles by Haider, W.

---

CARDIOVASCULAR ANESTHESIA

Pulmonary Artery Thromboendarterectomy: A Comparison of Two Different Postoperative Treatment Strategies

Peter Mares, MD^*, Timothy B. Gilbert, MD^||, Edda M. Tschernko, MD^*, Michael Hiesmayr, MD^*, Manfred Muhm, MD^*, Andreas Herneth, MD, Sharoukh Taghavi, MD, Walter Klepetko, MD, Irene Lang, MD^§, and Wolfram Haider, MD^*

Departments *Cardiothoracic Anesthesia and Intensive Care, Radiology, Cardiothoracic Surgery, and §Cardiology, University of Vienna, Vienna, Austria; and ||Department of Cardiothoracic Anesthesia, University of Maryland, Baltimore, Maryland

Address correspondence and reprint requests to Peter Mares, MD, Department of Cardiothoracic Anesthesia and Intensive Care, Vienna General Hospital, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

Pulmonary artery thromboendarterectomy (PTE) is a potentially curative surgical procedure for chronic thromboembolic pulmonary hypertension. It is, nevertheless, associated with considerable mortality caused by postoperative complications, such as reperfusion pulmonary edema (RPE) (i.e., pulmonary infiltrates in regions distal to vessels subjected to endarterectomy) and right heart failure (RHF). However, there are no reports about the influence of different postoperative treatment strategies on complications and mortality. Therefore, we compared two different treatment strategies. In Group I (n = 33), positive inotropic catecholamines and vasodilators were avoided during termination of cardiopulmonary bypass (CPB) and thereafter, and mechanical ventilation was performed with low tidal volumes < 8 mL/kg, duration of inspiration:duration of expiration = 3:1, and peak inspiratory pressures < 18 cm H₂O. In Group II (n = 14), positive inotropic catecholamines and vasodilators were regularly used for termination of CPB and thereafter, and ventilation was performed with high tidal volumes (10–15 mL/kg) and peak inspiratory pressures up to 50 cm H₂O. Hemodynamics, the incidence of RPE and RHF, duration of ventilation, morbidity, and mortality were recorded. Cardiac index was comparable before surgery (2.11 ± 0.09 vs 2.08 ± 0.09 L · min^-1 · m^-2) and 20 min after CPB (2.26 ± 0.09 vs 2.60 ± 0.20 L · min^-1 · m^-2). RPE occurred in 6.1% (Group I) versus 14.3% (Group II), and RHF was observed in 9.1% (Group I) versus 21.4% (Group II). Mortality was 9.1% (Group I) versus 21.4% (Group II). Thus, the avoidance of positive inotropic catecholamines and vasodilators in combination with nonaggressive mechanical ventilation after PTE was associated with a low incidence of RPE, RHF, duration of ventilation, and mortality after PTE.

Implications: The avoidance of positive inotropic catecholamines and vasodilators in combination with nonaggressive mechanical ventilation was associ- ated with a low incidence of reperfusion pulmonary edema and/or right heart failure after pulmonary artery thromboendarterectomy.

This article has been cited by other articles:

				N. Saouti, W. J. Morshuis, R. H. Heijmen, and R. J. Snijder Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a single institution experience Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 947 - 952. [Abstract] [Full Text] [PDF]

				K. McNeil and J. Dunning Chronic thromboembolic pulmonary hypertension (CTEPH) Heart, September 1, 2007; 93(9): 1152 - 1158. [Full Text] [PDF]

				H. Matsuda, H. Ogino, K. Minatoya, H. Sasaki, N. Nakanishi, S. Kyotani, J. Kobayashi, T. Yagihara, and S. Kitamura Long-term recovery of exercise ability after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ann. Thorac. Surg., October 1, 2006; 82(4): 1338 - 1343. [Abstract] [Full Text] [PDF]

				E. Mayer and W. Klepetko Techniques and Outcomes of Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension Proceedings of the ATS, September 1, 2006; 3(7): 589 - 593. [Abstract] [Full Text] [PDF]

				M. Sato, M. Ando, A. Muto, Y. Kondo, R. Hoshino, T. Nishibe, and M. Yamashita Two cases of chronic pulmonary thromboembolism saved by postoperative use of a percutaneous cardiopulmonary support device. Ann. Thorac. Surg., July 1, 2006; 82(1): 314 - 316. [Abstract] [Full Text] [PDF]

				F. Langer, M. Bauer, D. Tscholl, R. Schramm, T. Kunihara, H. Lausberg, T. Georg, H. Wilkens, and H.-J. Schafers Circulating big endothelin-1: An active role in pulmonary thromboendarterectomy? J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1342 - 1347. [Abstract] [Full Text] [PDF]

				H. R. Buller, G. Agnelli, R. D. Hull, T. M. Hyers, M. H. Prins, and G. E. Raskob Antithrombotic Therapy for Venous Thromboembolic Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 401S - 428S. [Abstract] [Full Text] [PDF]

				F. Langer, R. Schramm, M. Bauer, D. Tscholl, T. Kunihara, and H.-J. Schafers Cytokine Response to Pulmonary Thromboendarterectomy Chest, July 1, 2004; 126(1): 135 - 141. [Abstract] [Full Text] [PDF]

				P. F. Fedullo, W. R. Auger, K. M. Kerr, and L. J. Rubin Chronic Thromboembolic Pulmonary Hypertension N. Engl. J. Med., November 15, 2001; 345(20): 1465 - 1472. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999