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J Thorac Cardiovasc Surg 2007;133:510-516
© 2007 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Six-minute walk distance as parameter of functional outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension

^a Department of Pulmonology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
^b Department of Cardiothoracic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

Received for publication June 13, 2006; revisions received October 2, 2006; accepted for publication October 9, 2006.

^_* Reprint requests: Paul Bresser, MD, PhD, Academic Medical Centre, University of Amsterdam, Department of Pulmonology, F5-144, PO Box 22700, 1100 DE Amsterdam, The Netherlands (Email: P.Bresser{at}amc.uva.nl).

OBJECTIVES: In chronic thromboembolic pulmonary hypertension, objective data to assess the functional outcome after pulmonary endarterectomy are lacking. We studied the 6-minute walk distance in relation to the clinical and hemodynamic severity of disease, and assessed the effect of pulmonary endarterectomy on the 6-minute walk distance.

METHODS: A total of 50 consecutive patients with chronic thromboembolic pulmonary hypertension were studied. Subsequently, pulmonary endarterectomy was performed in 42 patients, 35 of whom underwent a 6-minute walk distance 1 year after surgery.

RESULTS: The mean ± standard error of the mean 6-minute walk distance was 391 ± 19 m. The 6-minute walk distance decreased in proportion to New York Heart Association functional class and correlated (all P < .0001) with mean pulmonary artery pressure (r = –0.62), cardiac output (r = 0.76), total pulmonary resistance (r = –0.75), mixed venous oxygen saturation (r = 0.77), and brain natriuretic peptide (r = –0.65). One year after pulmonary endarterectomy, the 6-minute walk distance increased from 417 ± 19 m to 517 ± 16 m (P < .0001). The change from baseline in 6-minute walk distance correlated with the changes after 1 year in New York Heart Association functional class (P < .01) and brain natriuretic peptide (r = 0.57, P < .002), and with the observed hemodynamic changes directly after pulmonary endarterectomy (change in mean pulmonary artery pressure: r = 0.52; change in cardiac output: r = 0.70; change in total pulmonary resistance r = 0.70; all P < .001). In patients with residual pulmonary hypertension after pulmonary endarterectomy, the 6-minute walk distance was significantly lower than in hemodynamically normalized patients. However, the absolute increase in the 6-minute walk distance was higher in patients with residual pulmonary hypertension (137 ± 26 m and 82 ± 20 m, respectively; P = .03).

CONCLUSIONS: The 6-minute walk distance was demonstrated to reflect the clinical and hemodynamic severity of disease in patients with chronic thromboembolic pulmonary hypertension. One year after pulmonary endarterectomy, the 6-minute walk distance had increased significantly, and the change in the 6-minute walk distance correlated with the observed clinical and hemodynamic improvement.

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