Features of Hospital Period in Patients Who Underwent Surgical Treatment for Chronic Thromboembolic Pulmonary Hypertension in Combination With Myocardial Revascularization

AIM OF THE STUDY. To study the features of hospital period after pulmonary endarterectomy (PEA) and coronary artery bypass grafting (CABG) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and surgically significant coronary artery (CA) stenosis, and to conduct a comparative analysis with hospital period after PEA in patients with CTEPH without CA lesions.

MATERIAL AND METHODS. An analysis of 141 patients with CTEPH was carried out. The average age is 53.5 (42.7-68.9) years. The 1st group (38 people) consisted of patients with CTEPH and surgically significant CA lesions, the 2nd group (103 people) — without surgically significant CA lesions. An intergroup analysis of clinical and functional data and the course of the early postoperative period was carried out.

RESULTS. According to clinical data, the 1st group of patients with CTEPH was characterized by older age (p=0.003), a larger proportion of patients with concomitant type 2 diabetes (p=0.004), arterial hypertension (p<0.001), atherosclerosis of the brachiocephalic arteries ≤ 50% (p<0.001), a history of myocardial infarction (p=0.008), and a higher comorbidity index (p=0.03) compared to the 2nd group of patients. The early postoperative period was more severe in the 1st group of patients with CTEPH, where a higher proportion of patients with the development of neurological disorders (p=0.02), newly diagnosed atrial fibrillation (p=0.04), and a higher proportion of patients with prolonged artificial ventilation (p=0.03) were identified. No intergroup differences were found in hospital mortality (p=0.74).

CONCLUSIONS. 1. In patients who underwent PEA in combination with myocardial revascularization, the hospital period is characterized by a more severe course in comparison with patients with CTEPH but without coronary artery disease. This is reflected in a higher incidence of neurological disorders, rhythm disturbances, and prolonged mechanical ventilation. 2. In-hospital mortality between the group of patients who underwent combined intervention and isolated PEA did not differ, despite the impact of concomitant pathology.

1. Chazova IE. Chronic thromboembolic pulmonary hypertension: current diagnostic and treatment options: A review. Terapevticheskii arkhiv. 2023;95(12):1017–1021. (In Russ.) https://doi.org/10.26442/00403660.2023.12.202495

2. Kamenskaya OV, Klinkova AS, Loginova IY, Porotnikova SS, Volkova II, Doronin DV, et al. Clinical and functional status and postoperative complications in patients with chronic thromboembolic pulmonary hypertension in the age aspect. Systemic Hypertension. 2023;20(4):31–37. (In Russ.). https://doi.org/10.38109/2075-082X-2023-4-31-37

3. Chernyavsky AM, Edemsky AG, Chernyavsky MA, Tarkova AR, Novikova NV, Ivanov SN. Surgical Techniques in Treatment of Patients With Chronic Postembolic Pulmonary Hypertension. Russian Journal of Cardiology and Cardiovascular Surgery. 2016;9(6):38–43. (In Russ.). https://doi.org/10.17116/kardio20169638-43

4. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al.; American Society of Echocardiography’s Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79–108. PMID: 16458610 https://doi.org/10.1016/j.euje.2005.12.014

5. Golitsyn SP, Kropacheva ES, Maykov EB, Mironov NYu, Panchenko EP, Sokolov SF, et al. Diagnosis and Management of Cardiac Arrhythmias. National clinical guidelines (PART I). Russian Cardiology Bulletin. 2014;9(2):3–52. (In Russ.)

6. Liu Z, Liu X, Lin F, Zheng X, Yang Y, Zhang Y, et al. Duration of regional cerebral oxygen saturation under 40% is a risk factor for neurological injury following pulmonary thromboendarterectomy: A prospective observational study. J Card Surg. 2022;37(9):2610–2617. PMID: 35599016 https://doi.org/10.1111/jocs.16615

7. Raffa GM, Agnello F, Occhipinti G, Miraglia R, Lo Re V, Marrone G, et al. Neurological complications after cardiac surgery: a retrospective case-control study of risk factors and outcome. J Cardiothorac Surg. 2019;14(1):23. PMID: 30683130 https://doi.org/10.1186/s13019-019-0844-8

8. Kirtbaia LN. Epidemiology and mechanism of atrial fibrillation development after coronary interventions. Annaly aritmologii. 2021;18(4):247–253. (In Russ.) https://doi.org/10.15275/annaritmol.2021.4.7

9. Chazova IE, Martynyuk TV. Problems of diagnosis and treatment of chronic thromboembolic pulmonary hypertension. Pacific Medical Journal. 2017;(4):6–16. (In Russ.) https://doi.org/10.17238/PmJ1609-1175.2017.4.6-16