J. Maxwell Chamberlain Memorial paper: cardiovascularPulmonary endarterectomy: experience and lessons learned in 1,500 cases
Section snippets
Patient selection
The first pulmonary thromboendarterectomy operation at UCSD was done in 1970 [1], and 188 operations were carried out in the ensuing 20 years. The program has grown steadily since 1990, and 1,580 patients had been operated on by December 2002. Patients are referred nationally and internationally to this center, and the number of referrals increases yearly, indicating an increased awareness of the disease and the effectiveness of therapy rather than an increased incidence. The clinical
Results
There is undoubtedly a learning curve for the operation. The operative mortality rate was 17% for the first 200 patients in the beginning of the UCSD series (1970 to 1990). Changes were made in the operative technique in 1990 [3], and the perioperative mortality rate has since steadily declined, to 8.8% for the 500 individuals who had the operation between 1994 and 1998, and to 4.4% for the 500 patients operated on between 1998 and 2002.
The cohort of 500 consecutive patients was analyzed in
Unappreciated incidence
Pulmonary hypertension as a result of pulmonary embolism is an unappreciated but major cause of morbidity and mortality. Its incidence is difficult to calculate because of the uncertainty regarding the frequency of acute pulmonary embolism and the proportion of patients with acute pulmonary emboli in whom embolic residua fail to resolve. In 1975, Dalen and Alpert [5] calculated that pulmonary embolism resulted in 630,000 symptomatic episodes in the United States, making it about half as common
Acknowledgements
Cleonice Gordon and David Garcia were invaluable in data analysis. Reena Deutsch assisted in the statistical analysis. Reena Deutsch is funded by General Clinical Research Center grant National Institutes of Health M01 RR00827.
References (19)
- et al.
Successful surgical intervention in severe chronic thromboembolic pulmonary hypertension
Chest
(1973) - et al.
Pulmonary endarterectomy
Curr Prob Surg
(2000) - et al.
Experience and results of 150 pulmonary thromboendarterectomy operations over a 29 month period
J Thorac Cardiovasc Surg
(1993) - et al.
Operative classification of thromboembolic disease determines outcome after pulmonary endarterectomy
J Thorac Cardiovasc Surg
(2002) - et al.
Human angiopoietin gene expression is a marker for severity of pulmonary hypertension in patients undergoing pulmonary thromboendarterectomy
J Thorac Cardiovasc Surg
(2001) - et al.
The syndrome of chronic thromboembolism of the major pulmonary arteries
Am J Med
(1956) - et al.
Long term follow-up of patients with pulmonary embolism. Late prognosis and evolution of hemodynamic and respiratory data
Chest
(1982) - et al.
Prognostic factors in medically treated patients with chronic pulmonary embolism
Chest
(2001) Chronic obstruction of major pulmonary arteries
Am J Med
(1950)
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