Hemodynamic and functional effectiveness of the patient undergoing pulmonary thromboendarterectomy

Abstract

Objective: to evaluate the hemodynamic and functional effectiveness of the patient undergoing thromboendarterectomy. Methods: a descriptive study of series of cases in postoperative patients of thromboendarterectomy from 2002 to 2016 with complete records was carried out. The data collection was done with an "ex profeso" sheet of 10 demographic items, 2 of somatometry, 6 hemodynamics, 1 functional, 6 gasometric and 9 of perfusion conduction, with open and dichotomous responses. For the data analysis, descriptive statistics, U Mann-Whitney tests and Kaplan-Meier survival analysis were applied; the significance was set at p <0.05. Results: 25 patients were studied, male prevalence (68%), age 43 ± 18 years. The cardiopulmonary bypass time was 222 ± 73 min. and the aortic clamp of 121 ± 71 min; in 80%total circulatory arrest was performed for periods of 20 min and reperfusion times of 10 min between each one. 20% of the patients were managed with selective cerebral perfusion. Thromboendarterectomy decreased pulmonary vascular resistance (p <0.0001) and mean pulmonary arterial pressure (p = 0.001) and increased cardiac output (p = 0.009), PaO2 (p = 0.035) and SaO2 (p = 0.015). 72% improved the functional class from III-IV to I-II. There was mortality of 20% associated to persistence of pulmonary arterial hypertension and the three-year survival was 80%. Two patients required ECMO A-V both successful. Conclusion: Thromboendarterectomy is the treatment of choice for patients with chronic pulmonary thromboembolism, significantly improving hemodynamic and functional parameters, reflected in their quality of life and survival.