Elsevier

Annals of Vascular Surgery

Volume 51, August 2018, Pages 254-261
Annals of Vascular Surgery

Clinical Research
Determinants of Health-Related Quality of Life 1 Year after Pulmonary Thromboendarterectomy

https://doi.org/10.1016/j.avsg.2018.02.019Get rights and content

Background

Pulmonary thromboendarterectomy (PTE) is a recognized treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH), with good long-term hemodynamic results. The aim of this study was to test the hypothesis that the dynamics of health-related quality of life (QoL), 1 year after PTE, depend both on the clinical determinants associated with the underlying disease and the adverse events occurring in the early postoperative period.

Methods

This prospective cohort study included 136 patients with CTEPH. All patients before and after PTE (1-year follow-up) were examined in terms of QoL, by using the Short Form 36 Health Survey Questionnaire.

Results

One year after PTE, a significant improvement in the QoL of patients was observed in all subscales of the Short Form 36 Health Survey Questionnaire, except in the general health scale. Multivariate analysis showed that the predictors adversely affecting the dynamics of QoL after PTE were the presence of comorbidities (such as chronic obstructive pulmonary disease [COPD] and coronary artery disease) and early postoperative complications (specific ones for this category of patients are residual pulmonary hypertension and neurological complications, and nonspecific ones are atrial fibrillation and heart failure).

Conclusions

The determinants that affect the dynamics of QoL 1 year after PTE in patients with CTEPH were the presence of comorbidities (COPD and coronary artery disease) and adverse events in the early postoperative period (residual pulmonary hypertension, neurological complications, atrial fibrillation, and heart failure).

Introduction

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important cause of severe pulmonary hypertension and is associated with significant morbidity and mortality.1 Pulmonary thromboendarterectomy (PTE) offers a potential surgical remedy for patients with chronic pulmonary thromboembolism. Removal of organized thromboembolic material from major pulmonary vessels can restore pulmonary hemodynamics to normal or near-normal levels in most patients undergoing this operation.2, 3 However, there is limited information about the long-term effects of PTE, including its effect on the quality of life (QoL).

The assessment of QoL before and after surgery provides an important insight into the broader effect of the disease because clinical symptoms and objectively measurable clinical parameters do not always completely represent the effect of surgical treatment on the patient's daily life.4 Nevertheless, QoL has rarely been addressed in studies evaluating the treatment outcomes in patients with CTEPH although surgical treatment is associated with a high risk of different postoperative adverse events, including neurological disorders, specific and nonspecific pulmonary disorders, and other events in these patients.5, 6 Therefore, to make accurate decisions concerning further therapeutic strategies and allocation of resources and medical priorities to patients with CTEPH, a better understanding of their long-term QoL and prognosis after PTE is needed.

The aim of the present study was to test the hypothesis that the dynamics of health-related QoL 1 year after PTE depend both on the clinical determinants associated with the underlying disease and the adverse events occurring in the early postoperative period.

Section snippets

Study Design

We analyzed data from 136 patients who were diagnosed with CTEPH. Participants were recruited between August 2011 and February 2016. This prospective cohort study was conducted in compliance with the principles of the Declaration of Helsinki and had been approved by the local ethics committee. Written informed consent was obtained from all patients before their inclusion in this study.

The inclusion criterion was elective PTE, whereas the exclusion criteria were emergency surgery, recent or

Baseline Characteristics of Patients with CTEPH

A total of 136 patients undergoing PTE were enrolled in this study. The baseline characteristics of patients with CTEPH are presented in Table I.

The mean patient age was 49.4 years (range, 21–71 years), and slightly more than half of the patients participating in this study were men (57.4%). There were no gender differences with respect to mean age (men: 48.7 ± 10.5 years vs. women: 51.1 ± 11.5 years, P = 0.287). All examined patients had a proximal level of obstruction in the pulmonary

Discussion

PTE, involving the removal of obstructive material, is the only curative treatment for CTEPH. However, it should be remembered that CTEPH is a powerful limiting factor for physical and emotional functioning, and its negative effect continues after PTE because long-term pulmonary hypertension and hypoxemia that developed in the background hamper rapid recovery.12, 13

In the present study, we found that the determinants adversely affecting the dynamics of QoL after PTE can be classified into 2

Conclusion

The present study demonstrates that despite the success of PTE, there are many factors that can affect the recovery period and QoL after surgery in patients with CTEPH. According to the results of our study, the presence of comorbidities in patients with CTEPH, such as COPD and coronary artery disease, and early postoperative complications after PTE (residual pulmonary hypertension and neurological disorders specific to such patients, and nonspecific complications such as atrial fibrillation

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  • Funding: This study has no financial support or funding.

    Conflicts of interest: The authors declare that they have no conflict of interest.

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