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J Thorac Cardiovasc Surg 2007;133:162-168
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Reverse right ventricular remodeling after pulmonary endarterectomy

Andrea M. D’Armini, MDa,*, Giorgio Zanotti, MDa, Stefano Ghio, MDb, Giulia Magrini, MDb, Matteo Pozzi, MDa, Laura Scelsi, MDb, Giulia Meloni, MDc, Catherine Klersy, MDd, Mario Viganò, MDa

a Division of Cardiac Surgery, University of Pavia School of Medicine, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
b Division of Cardiology, University of Pavia School of Medicine, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
c Institute of Radiology, University of Pavia School of Medicine, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
d Biostatistics Unit, University of Pavia School of Medicine, Fondazione IRCCS San Matteo Hospital, Pavia, Italy.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication April 24, 2006; revisions received August 27, 2006; accepted for publication August 31, 2006.

* Address for reprints: Andrea M. D’Armini, MD, Division of Cardiac Surgery, University of Pavia School of Medicine, Fondazione IRCCS San Matteo Hospital, Piazzale Golgi 19, 27100 Pavia, Italy. (Email: darmini{at}smatteo.pv.it).

OBJECTIVES: We sought to evaluate the capability of the right ventricle to regain normal morphology and function after pulmonary endarterectomy, to correlate right ventricular reverse remodeling with functional status, and to identify independent predictors of clinical failure after surgical intervention.

METHODS: From December 2000 through August 2003, 45 patients underwent isolated pulmonary endarterectomy. Morphology and function of the right ventricle were studied by using a combination of right heart catheterization, cardiac magnetic resonance, and transthoracic echocardiography. Functional status was evaluated by using New York Heart Association class. Full preoperative data were available for 37 candidates. All patients were evaluated before discharge, at 3 months, and at 1, 2, and 3 years postoperatively using the same modalities.

RESULTS: Immediately after surgical intervention, right ventricular cavitary dimensions decreased significantly, and tricuspid regurgitation radically improved. Right ventricular ejection fraction and functional status improved and right ventricular hypertrophy reversed over a longer time period. Higher ventricular dimensions and lower ejection fraction of the right ventricle were associated with poorer functional status at any time postoperatively. At discharge, pulmonary vascular resistance of greater than 509 dyne · sec · cm–5 and right ventricular ejection fraction of 24% or less predicted clinical failure at 12 months’ follow-up.

CONCLUSIONS: After pulmonary endarterectomy, the right ventricle recovers and maintains normal architecture and function over time, regardless of the severity of preoperative disease. Accurate preoperative evaluation of the hemodynamics and anatomy of the thromboembolic lesions are mandatory. If pulmonary endarterectomy is not expected to decrease pulmonary vascular resistance to less than 509 dyne · sec · cm–5, indication for surgical intervention needs to be carefully evaluated.

Abbreviations and Acronyms CTEPH = chronic thromboembolic pulmonary hypertension; NYHA = New York Heart Association; PEA = pulmonary endarterectomy; PVR = pulmonary vascular resistance


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