经皮腔内肺动脉成形术治疗慢性血栓栓塞性肺动脉高压的有效性及安全性评估

Efficacy and safety of percutaneous transluminal pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

目的评估经皮腔内肺动脉成形术(PTPA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)患者的有效性和安全性。方法该研究为前瞻性单臂试验。纳入2017年1月至2019年6月武汉亚洲心脏病医院心外科确诊的CTEPH患者。以明确诊断CTEPH的时间为基线,收集入选患者的基线临床资料,包括年龄、性别、世界卫生组织(WHO)功能分级、6 min步行距离、N末端B型利钠肽原(NT-proBNP)水平以及右心导管测定的血流动力学指标等。患者分次行PTPA,统计每位患者扩张血管数,术后24周随访并复查右心导管。记录手术安全性指标,包括全因死亡、围术期并发症、再灌注肺水肿等。结果共入选患者19例,年龄(56.3±12.5)岁,男性7例。入选患者分别进行了1~7次PTPA,总计56次,累计扩张肺动脉260支,每次扩张血管(5.14±2.36)支。共13例患者测定了6 min步行距离,为(307±130)m。入选患者PTPA术后均自述体力明显改善,尤其以第一次手术后为著。PTPA术后24周,入选患者平均肺动脉压由基线的(40.11±7.55)mmHg(1 mmHg=0.133 kPa)降至(27.53±4.75)mmHg(P<0.001),全肺阻力由基线的(13.00±3.56)Wood单位降低至(5.48±1.56)Wood单位(P<0.001),心输出量由基线的(3.19±0.63)L/min提高至(5.23±0.90)L/min(P<0.001)。PTPA术后24周,入选患者WHO功能分级明显改善(P<0.001),NT-proBNP明显降低(P=0.002),6 min步行距离由基线的(307.08±129.51)m延长至(428.00±112.64)m(P=0.002)。随访期内无患者死亡;4例患者术中发生咯血,共计7例次,均未导致严重不良后果;1例患者发生再灌注性肺水肿,治疗后康复。结论PTPA可改善CTEPH患者的血流动力学及心功能指标,且安全性良好。

Objective To explore the efficacy and safety of percutaneous transluminal pulmonary angioplasty(PTPA)in patients with chronic thromboembolic pulmonary hypertension(CTEPH).Methods This prospective single arm study included 19 CTEPH patients(7 male,age(56.3±12.5)years)admitted to Wuhan Asia Heart Hospital from January 2017 to June 2019 and received PTPA interventional therapy.Baseline data,including age,sex,WHO functional class,6-minute walk distance(6MWD),NT-proBNP,right heart catheterization values,were collected.Patients received single or repeated PTPA.Number of dilated vessels from each patient was analyzed,patients were followed up for 24 weeks and right heart catheterization was repeated at 24 weeks post initial PTPA.All-cause death,perioperative complications,and reperfusion pulmonary edema were reported.WHO functional class,6MWD,NT-proBNP,right heart catheterization values were compared between baseline and at 24 weeks follow up.Results Nineteen CTEPH patients received a total of 56 PTPA treatments.The pulmonary artery pressure(mPAP)decreased from(40.11±7.55)mmHg(1 mmHg=0.133 kPa)to(27.53±4.75)mmHg(P<0.001),and the total pulmonary resistance(TPR)decreased from(13.00±3.56)Wood U to(5.48±1.56)Wood U(P<0.001),cardiac output increased from(3.19±0.63)L/min to(5.23±0.94)L/minutes(P<0.01)at 24 weeks post PTPA.The WHO functional class improved significantly(P<0.001),6MWD increased from(307.08±129.51)m to(428.00±112.64)m(P=0.002),the NT-proBNP decreased at 24 weeks post PTPA(P=0.002).During the follow-up period,there was no death;hemoptysis occurred in 4 patients during the operation,none of which resulted in serious adverse clinical consequences.One patient developed reperfusion pulmonary edema and recovered after treatment.Conclusion PTPA treatment is safe and can significantly improve the hemodynamics and WHO functional class of patients with CTEPH.