Patients with chronic thromboembolic pulmonary hypertension who undergo pulmonary endarterectomy (PEA) require lifelong anticoagulation, yet the optimal regimen after surgery remains uncertain. Although vitamin K antagonists (VKAs) are traditionally used, direct oral anticoagulants (DOACs) have gained attention as potentially safer and more convenient alternatives. This systematic review and meta-analysis aims to evaluate the efficacy and safety of DOACs compared with VKAs in the post-PEA population. We systematically searched three English and four Chinese databases for relevant studies published up to March 2025. Risk of bias was evaluated using RoB 2 for RCTs and ROBINS-I for observational studies. Outcomes included venous thromboembolism (VTE), pulmonary embolism (PE) recurrence, bleeding events, and all-cause mortality. Pooled risk ratios (RRs) with 95

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by a unique combination of mechanical obstruction resulting from organized thrombi and a variable degree of secondary small-vessel remodeling, both of which contribute to increased pulmonary vascular resistance. In this process, pulmonary artery smooth muscle cell (SMC) phenotypic switching plays a critical role in the progression of microvascular disease. However, the underlying molecular mechanisms remain incompletely elucidated. Single-cell RNA sequencing (scRNA-seq) data from CTEPH patients and normal pulmonary artery tissues (GSE224143, GSE228644) were integrated. After data preprocessing, unsupervised clustering, and cell type annotation using Seurat, we focused on SMC subtype analysis and constructed functional landscapes via pseudobulk DESeq2, Gene Ontology (GO) enrichment analysis, Monocle3 pseudotime trajectory analysis, and high-dimensional weighted gene co-expression network analysis (hdWGCNA). Core findings were validated using bulk RNA-seq datasets (GSE84538) and experimental approaches, including Western blotting, immunofluorescence, EdU proliferation assay, and Transwell/scratch wound healing migration assay. scRNA-seq analysis identified 18 distinct cell clusters in pulmonary vascular tissues. Compared with controls, CTEPH tissues showed reduced fibroblasts and increased immune cells (T cells, monocytes/macrophages) and SMCs. Four SMC phenotypes were identified, with a marked expansion of fibroblast-like SMCs in CTEPH and a dynamic transition from contractile to fibroblast-like phenotype confirmed by pseudotime analysis. Upregulated genes in CTEPH SMCs were enriched in extracellular matrix organization and TGF-β signaling pathways (significantly activated). Cross-validation via hdWGCNA, pseudotime trajectory, and bulk RNA-seq data identified NDRG1 (a hypoxia-inducible gene) as a core gene. NDRG1 was significantly overexpressed in CTEPH SMCs and tissues, positively correlating with pulmonary vascular resistance (PVR). Functional experiments showed that NDRG1 knockdown inhibited hypoxia-induced migration/proliferation of human pulmonary artery smooth muscle cells (HPASMCs), suppressed TGF-β/SMAD pathway activation, and reduced fibroblast-like phenotype marker (Vimentin, COL1A1) expression. NDRG1 is associated with SMC phenotypic switching toward the fibroblast-like phenotype and promotes pulmonary vascular remodeling in CTEPH via the TGF-β/SMAD pathway. NDRG1 and related key gene axes may serve as potential therapeutic targets for CTEPH.

Residual pulmonary hypertension (RPH) is a major postoperative complication after pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and is associated with worse recovery and prognosis. This study evaluated the predictive value of the preoperative tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio, a non-invasive surrogate of right ventricular-pulmonary arterial (RV-PA) coupling, for early RPH. We retrospectively analyzed 183 consecutive patients with CTEPH who underwent PEA at a high-volume national center between December 2017 and September 2025. Early RPH was defined as a postoperative mean pulmonary artery pressure (mPAP) > 30 mmHg. Independent predictors were identified using multivariable logistic regression. Predictive performance and model improvement were evaluated in the complete-case cohort using the area under the receiver operating characteristic curve (AUC), the likelihood ratio test, integrated discrimination improvement (IDI), and continuous net reclassification index (NRI). Internal validation was performed using 1,000 bootstrap resamples. Early RPH occurred in 48 patients (26.23

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is driven by unresolved pulmonary arterial thrombi and involves complex processes such as vascular remodeling and immune dysregulation. Early identification of molecular markers may support more accurate diagnosis and individualized therapy.Methods We integrated anthropometric and biochemical data with single-cell RNA sequencing (scRNA-seq), DNA methylation, and Mendelian randomization (MR) analyses. scRNA-seq data were analyzed to determine altered cell populations and pathways. MR and colocalization analyses were conducted to identify genetically supported candidates related to CTEPH.Results scRNA-seq analysis revealed altered immune composition, with a modest increase in NK cells and an angiogenesis-associated enrichment of monocytes and HSC-G-CSF cells in CTEPH patients, accompanied by activation of toll-like receptor and MAPK signaling pathways. MR and colocalization identified several genetically associated genes-CLEC7A, TNFSF13B, LRP1, ETS1, and FGR-of which ETS1 and FGR demonstrated good diagnostic performance. DNA methylation analysis indicated marked alterations in chromatin assembly and epigenetic regulation.Conclusions This multi-omics study highlights critical genes, epigenetic features, and immune-related cell populations associated with CTEPH. These findings improve understanding of disease mechanisms and offer potential biomarkers for early diagnosis and personalized management.

Background:Differentiating pulmonary artery sarcoma (PAS) from pulmonary thromboembolism (PTE) based on CT pulmonary angiography (CTPA) is a big challenge, necessitating the incorporation of other methods, such as deep learning (DL). This study aimed to develop and validate a DL-based model, PVDNet, for differentiating PAS and PTE on CTPA. Methods:This study retrospectively analyzed CTPA image datasets from the prospective CHinese pulmOnary embolism multimodality Imaging artifiCial intelligencE (CHOICE) study to develop and validate a DL model for differentiating PAS from PTE. CTPA image datasets of 952 patients (470 acute PTE [APE], 363 chronic PTE [CPE], and 119 PAS) from 15 hospitals were included. The training set comprised CTPA images from 590 patients, and the internal test set comprised those from 186 patients, all obtained from the same three centers. CTPA images of 176 patients from 12 centers were used for external validation. A DL framework, PVDNet, was employed to perform fine-grained classification. Meanwhile, CTPA images in the external validation set were independently assessed by four radiologists with different levels of expertise. The main outcome measures were area under the curve (AUC) and the consistency test. Findings:In the internal test set, PVDNet achieved an AUC of 0.972, 0.902, and 0.900 for PAS (95% CI: [0.945, 0.994]), APE (95% CI: [0.855, 0.944]), and CPE (95% CI: [0.852, 0.946]), respectively. Furthermore, PVDNet model demonstrated effective differentiation between PAS and PTE, showing comparable AUC values to a senior radiologist specialized in pulmonary vascular diseases (SRPV) in the external validation set (0.973 vs. 0.943, p = 0.308). The model achieved moderate agreement with SRPV (kappa = 0.651, p < 0.001), which was the highest among four readers. Interpretation:PVDNet model could differentiate PAS from PTE, with performance approaching the proficiency level of a senior radiologist specializing in pulmonary vascular diseases. PVDNet's performance in distinguishing APE from CPE requires further optimization. Funding:National Natural Science Foundation of China (No. 82272081), Medical and Health Science and Technology Innovation Project of Chinese Academy of Medical Science (No. 2021-I2M-1-049), and the National Key Research and Development Program of China (No. 2023YFC2507200).

Background:The morphological differences in the pulmonary vascular tree between chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic disease (CTED) are not yet fully understood. This study aimed to use artificial intelligence (AI) segmentation technology to identify morphological markers that can be used to differentiate CTEPH from CTED using computed tomography pulmonary angiography (CTPA). Methods:We conducted a retrospective cohort study with consecutive patients diagnosed with CTEPH, CTED, and control subjects at the China-Japan Friendship Hospital from January 2019 to October 2023. The study involved the automatic quantification of the pulmonary blood volume (BV), tortuosity, and fractal dimension (FD) from CTPA images using an AI workstation. These morphological metrics were compared among the three groups using the Kruskal-Wallis test. Correlations between these metrics and the hemodynamic parameters were evaluated using Spearman's rank correlation coefficients. Additionally, a receiver operating characteristic (ROC) curve analysis was conducted to assess the discriminative ability of pulmonary artery tortuosity to differentiate between each pair of groups. Results:A total of 190 participants [57 years, interquartile range (IQR), 49-65 years, 97 men], including 116 CTEPH patients, 54 CTED patients, and 20 controls, were enrolled in this study. Pulmonary artery tortuosity in the control, CTED, and CTEPH groups showed a progressively increasing trend [1.07 (IQR, 1.06-1.10) vs. 1.10 (IQR, 1.07-1.14) vs. 1.14 (IQR, 1.10-1.18), P<0.01]. The area under the curve (AUC) values of pulmonary arterial tortuosity for differentiating between the CTEPH patients and controls, CTED patients and controls, and CTEPH patients and CTED patients were 0.859, 0.712, and 0.663, respectively. There was a positive correlation between pulmonary artery tortuosity and mean pulmonary arterial pressure (mPAP) (r=0.44, P<0.01), and pulmonary vascular resistance (PVR) (r=0.47, P<0.01). Additionally, the volume of the small- and medium-sized pulmonary arteries was significantly higher in the CTED patients than the CTEPH patients (P<0.01). The pulmonary arterial FD among the three groups was comparable (P=0.36). Conclusions:Pulmonary arterial tortuosity on CTPA had auxiliary diagnostic value in differentiating between CTEPH patients and controls, but its value in differentiating between CTED and CTEPH patients requires further study. The reduced volume of small- and medium-sized pulmonary arteries in CTEPH patients could indicate impaired pulmonary hemodynamics.

Objective Many studies have reported microbial signatures in thrombi at major vascular sites, such as the coronary artery and the middle cerebral artery, which are critical for maintaining proper blood flow and oxygenation. Chronic thromboembolic pulmonary hypertension (CTEPH) is a condition involving non-resolving thrombosis that has not been fully studied. This study explored the microbial taxonomy and functional profiles of both fresh and organized thrombi associated with CTEPH to investigate the role of microbiota in thrombus non-resolving. Methods In this study, 12 CTEPH fresh thrombi and 12 organized thrombi were collected from 14 patients with CTEPH. Metagenomic sequencing was employed to explore the genomic information of all microorganisms in the thrombus samples. Results Our data demonstrated a diverse range of microorganisms in CTEPH thrombi, whether fresh or organized. Notably, a considerable proportion (54.7 %) of sequencing data could not be classified into the relative microbial taxa, highlighting the complexity and novelty of the thrombus ecosystem. Although there were no significant differences in microbial community structure between the two groups, the abundance of dominant microbial species varied. Leuconostoc sp. DORA 2, Staphylococcus aureus, and Aliidongia dinghuensis were common dominant species in CTEPH thrombus. Organized thrombus significantly increased the relative abundance of Staphylococcus aureus, which was confirmed to effectively distinguish between organized and fresh thrombi by LeFSe analysis and random forest analysis. Functional annotation using both the KEGG and eggNOG databases revealed that organized thrombi exhibit stronger metabolic functions, particularly in amino acid metabolism. Conclusions Our findings suggest that microbial composition and function may play an important role in thrombus organization. Targeting inflammation to prevent thrombosis presents promising opportunities for further research in this area.

Background: In operable chronic thromboembolic pulmonary hypertension (CTEPH) patients, the utilization of bridging therapy with targeted medications prior to pulmonary endarterectomy (PEA) remains a topic of controversy, despite being common in cases of severe hemodynamic impairment. This study aims to assess the impact of riociguat as a bridging therapy on postoperative hemodynamics and outcomes. Methods: We conducted a retrospective study involving patients undergoing PEA from December 2016 to November 2023. Patients were categorized into two groups based on the use of riociguat before PEA. Pulmonary vascular resistance (PVR) following riociguat administration was assessed pre-PEA. Postoperative outcomes, including mortality, complications, and hemodynamics, were compared, employing propensity score matching analysis. Results: Among the patients, 41.8% (n=56) received riociguat as bridging therapy. In patients with PVR >= 800 dynesseccm(-5), riociguat resulted in a reduction in PVR {1,207 [974-1,698] vs. 1,125 [928-1,486] dynesseccm(-5), P<0.01}, while no significant difference was observed in patients with PVR <800 dynesseccm(-5) {641 [474-740] vs. 600 [480-768] dynesseccm(-5), P=0.46}. After propensity score matching, each group included 26 patients. The overall perioperative mortality rate was 2.6%. Postoperative PVR {326 [254-398] vs. 361 [290-445] dynesseccm(-5), P=0.35} was similar in the riociguat group compared to the control group. The incidence of residual pulmonary hypertension (PH) and other postoperative outcomes were also comparable. Conclusions: The use of riociguat as bridging therapy demonstrated hemodynamic improvement before PEA in patients with high preoperative PVR. However, no additional benefits in postoperative mortality or hemodynamics were observed.

Objective Pulmonary artery sarcoma (PAS) is an exceedingly rare and insufficiently investigated disease, leading to uncertain in its optimal management. This study aims to present our institutional experience and the outcomes of pulmonary endarterectomy for PAS.Methods We gathered clinical characteristics, intraoperative data, postoperative outcomes, and prognosis information from PAS patients who underwent surgical treatment at our institution between December 2016 and September 2023.Results A total of 20 patients with PAS underwent pulmonary endarterectomy. The median age of the patients was 52 (IQR 45, 57) years, with 12 patients (60%) being female. Intimal sarcoma was confirmed in 19 patients, while the remaining one was diagnosed with large cell neuroendocrine carcinoma. The perioperative mortality rate was three cases (15%). Follow-up was conducted for a median duration of 14 months (range: 1-61). During the follow-up period, 11 patients experienced recurrence or metastasis, and 5 patients succumbed to the disease. The estimated cumulative survival rates at 1 and 2 years for all 20 patients were 66.4% and 55.3%, respectively.Conclusion Pulmonary endarterectomy emerges as a palliative but effective approach for managing PAS, particularly when complemented with postoperative therapies such as chemotherapy and targeted therapy, which collectively contribute to achieving favorable long-term survival outcomes.

BackgroundNew-onset postoperative atrial fibrillation (POAF) is a common complication after pulmonary thromboendarterectomy (PEA), yet the risk factors and their impact on prognosis remain poorly understood. This study aims to investigate the risk factors associated with new-onset POAF after PEA and elucidate its underlying connection with adverse postoperative outcomes.MethodsA retrospective analysis included 129 consecutive chronic thromboembolic pulmonary hypertension (CTEPH) patients and 16 sarcoma patients undergoing PEA. Univariate and multivariate analyses were conducted to examine the potential effects of preoperative and intraoperative variables on new-onset POAF following PEA. Propensity score matching (PSM) was then employed to adjust for confounding factors.ResultsBinary logistic regression revealed that age (odds ratio [OR] = 1.041, 95% confidence interval [CI] = 1.008–1.075, p = 0.014) and left atrial diameter[LAD] (OR = 1.105, 95% CI = 1.025–1.191, p = 0.009) were independent risk factors for new-onset POAF after PEA. The receiver operating characteristic (ROC) curve indicated that the predictive abilities of age and LAD for new-onset POAF were 0.652 and 0.684, respectively. Patients with new-onset POAF, compared with those without, exhibited a higher incidence of adverse outcomes (in-hospital mortality, acute heart failure, acute kidney insufficiency, reperfusion pulmonary edema). Propensity score matching (PSM) analyses confirmed the results.ConclusionAdvanced age and LAD independently contribute to the risk of new-onset POAF after PEA. Patients with new-onset POAF are more prone to adverse outcomes. Therefore, heightened vigilance and careful monitoring of POAF after PEA are warranted.

Background:Acute kidney injury (AKI) is a common and life-threatening complication following pulmonary endarterectomy (PEA). Our study aimed to investigate the risk factors associated with AKI and evaluate the correlation between serum myoglobin (sMb) levels and postoperative AKI.Methods:We conducted a retrospective study involving 134 patients who underwent PEA at China-Japan Friendship Hospital. AKI was defined and staged according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.Results:During the study period, the incidence of postoperative AKI was 57.5%, and the associated mortality rate was 6.0%. Severe AKI was found to be significantly associated with worse short-term outcomes (P<0.05). Logarithmically transformed postoperative day (POD) 0 sMb levels were significantly associated with AKI [odds ratio (OR) =5.174; 95% confidence interval (CI), 2.307-11.603; P<0.001] and severe AKI (OR =4.605; 95% CI, 1.510-14.048; P=0.007), also had independent predictive value [area under the curve (AUC) =0.776 in AKI and AUC =0.737 in severe AKI]. The optimal cut-off values were 370.544 ng/mL for AKI and 419.473 ng/mL for severe AKI. Furthermore, albumin concentration was found to play a protective role in the development of severe AKI (OR =0.838; 95% CI, 0.716-0.980; P=0.027) when higher than 40.350 g/L.Conclusions:Our findings suggest that a high concentration of POD0 sMb may increase the risk of developing AKI following PEA surgery. Increasing albumin concentration could serve as an effective preventive measure against AKI.

Background:Pulmonary artery sarcoma (PAS) is a very rare malignancy with a poor prognosis; however, its clinical manifestations and imaging findings are often indistinguishable from pulmonary thromboembolism (PTE). We thus aimed to accurately diagnose PAS by comparing the clinical and computed tomography pulmonary angiography (CTPA) and magnetic resonance imaging (MRI) imaging characteristics of PAS and PTE.Methods:This case-control study retrospectively enrolled 20 patients with PAS (from March 2017 to September 2022), 40 patients with central acute PTE, and 40 patients with central chronic PTE (from January 2021 to December 2022) in the China-Japan Friendship Hospital. The following clinical and imaging findings were compared between the three groups: initial symptoms; D-dimer, C-reactive protein, and N-terminal pro B-type natriuretic peptide levels; wall-eclipsing sign (WES); scope of lesion involvement; and morphological characteristics. Signal intensity was also observed on different MRI sequences.Results:The D-dimer level in PAS was significantly lower than that in central acute PTE (P<0.001). The WES was present in 17 cases of PAS (85.0%), which was a greater proportion than that of the central acute PTE and chronic PTE groups (all P values <0.001). The involvement of the pulmonary valve or right ventricular outflow tract was observed in five PAS cases but none of the central acute PTE or chronic PTE cases (all P values =0.001). In 19 PAS cases (95.0%), the lesions grew expansively in the central pulmonary artery. The proximal margin of 18 patients with PAS (90.0%) was bulging or lobulated. Nine cases of PAS (45.0%) showed aneurysm-like dilatation (grape-like sign) of the distal pulmonary artery, representing significantly greater proportion than that of the central acute PTE and chronic PTE groups (all P values <0.001). In 37 patients with central acute PTE (92.5%), the clots were observed to be floating in the pulmonary artery lumen with saddle, tubular or polypoid shape. Eccentric filling defects attached to the pulmonary artery wall were observed in 32 cases of central chronic PTE (80.0%). On MRI, PAS lesions were hyperintense on fat-suppressed T2-weighted imaging and diffusion-weighted imaging, demonstrating heterogeneous enhancement.Conclusions:Comprehensive analysis of the clinical data and imaging features on CTPA and MRI can aid in the accurate differential diagnosis of PAS and PTE.

Abstract Objectives Our objective is to compare the right/left ventricular blood pool T1 ratio (RVT1/LVT1), and right/left ventricular blood pool T2 ratio (RVT2/LVT2) on Cardiac Magnetic Resonance Imaging (CMR) between patients with pulmonary hypertension (PH) and normal controls, to analyze the correlation of RVT1/LVT1, RVT2/LVT2 and hemodynamics measured with right heart catheterization (RHC) in patients with PH. Methods Forty two patients with PH and 40 gender-and age-matched healthy controls were prospectively included. All patients underwent RHC and CMR within 24 h. The right and left ventricular blood pool T1 and T2 values were respectively measured, and RVT1/LVT1 and RVT2/LVT2 between the PH group and the healthy control were compared. Meanwhile, the correlation between RVT1/LVT1, RV/LVT2 ratio and hemodynamic parameters in patients with PH respectively was analyzed. Results In the control group, RVT2 was significantly lower than LVT2 (t = 6.782, p < 0.001) while RVT1 also was lower than LVT1 (t = 8.961, p < 0.001). In patients with PH, RVT2 was significantly lower than LVT2 (t = 9.802, p < 0.001) while RVT1 was similar to LVT1 (t = − 1.378, p = 0.176). RVT2/LVT2 in the PH group was significantly lower than that in the control group (p < 0.001). RVT1/LVT1 in PH patients increased in comparison with the control group (p < 0.001). RVT2/LVT2 negatively correlated with pulmonary vascular resistance (r = − 0.506) and positively correlated with cardiac index (r = 0.521), blood oxygen saturation in Superior vena cava, right atrium, right ventricle and pulmonary artery (r = 0.564, 0.603, 0.648, 0.582). Conclusions RVT2/LVT2 on T2 mapping could be an additional CMR imaging marker that may assist to evaluate the severity of PH.

Objective: To investigate the incidence, risk factors, and outcomes of hyperlactatemia after pulmonary endarterectomy (PEA) under deep hypothermic circulatory arrest (DHCA). Methods: From December 2016 to January 2022, patients receiving PEA in China-Japan Friendship Hospital were enrolled in the study. Arterial blood samples were analyzed intraoperatively. Multivariate logistic regression analysis was performed to identify the predictors of intraoperative lactate elevation as well as major factors influencing the clinical outcome of the surgery. Results: A total of 110 patients (69 males and 41 females) were enrolled, aged (50.6±12.8) years. Receiver operating characteristic curve yielded an optimal cut-off lactate level of 7 mmol/L for predicting major postoperative complications (re-operation, re-intubation, postoperative renal failure requiring renal replacement therapy, wound infection, stroke, atrial fibrillation, and perioperative extracorporeal membrane oxygenation usage within 48 hours after surgery). Thirty-nine patients (35.5%) had an intraoperative peak arterial lactate level of≥7 mmol/L. According to intraoperative peak arterial lactate level, the patients were divided into two groups (<7 mmol/L and≥7 mmol/L). There were no statistically significant differences in age, sex and body mass index between the two groups (all P>0.05). Intraoperative peak lactate level was associated with prolonged mechanical ventilation time (r=0.262, P=0.008) and intensive care unit length of stay (r=0.304, P=0.002). Multivariate logistic regression analysis identified three key variables associated with lactate level≥7 mmol/L: DHCA duration (OR=1.186, 95%CI: 1.027-1.370, P=0.020), nadir hematocrit (HCT) (OR=0.580, 95%CI: 0.341-0.988, P=0.045) and preoperative pulmonary vascular resistance (PVR) (OR=1.096, 95%CI: 1.020-1.177, P=0.012). Patients with lactate≥7 mmol/L carried a higher rate of major complications (P=0.001). For patients with lactate≥7 mmol/L, 41.0% (16 out of 39 cases) had major complications, while for patients with lactate<7 mmol/L, only 14.1% (10 out of 71) had major complications. There was no statistically significant difference in mortality (8.5% vs 10.3%, P=0.753) between patients with different lactate levels. Moreover, intraoperative peak lactate level was a predictor of postoperative combined morbidity (OR=1.625, 95%CI: 1.176-2.245, P=0.003). Conclusion: High intraoperative lactate levels are associated with higher preoperative PVR, lower nadir HCT, and longer DHCA duration. Intraoperative lactate levels are independently associated with increased combined morbidity.

对于手术可及的慢性血栓栓塞性肺动脉高压(CTEPH)患者,肺动脉内膜剥脱术(PEA)是首选的治疗方案,因为手术有希望为患者带来根治机会.目前国内PEA手术仍处于起步阶段,能够规模开展PEA的中心并不多.在经验丰富的PEA中心,围手术期和术后病死率非常低,长期预后良好,术后3年生存率超过80％.CTEPH的治疗决策主要基于血栓栓塞的位置,对于肺动脉主干、叶及段水平的栓塞首选PEA,而肺动脉球囊成形术(BPA)主要治疗更远端的小血管.对于PEA或BPA术后残余或复发性肺动脉高压的患者,药物治疗也是一种选择.随着手术经验的增加和手术器械的改进,越来越多的患者可行手术治疗(包括一些亚段病变的患者).此外,PEA可以与其他治疗方式相结合,包括:(1)BPA及靶向药物治疗PEA术后残余或复发肺动脉高压患者;(2)BPA及靶向药物治作为PEA术前桥接治疗.目前关于这些联合疗法的临床数据很有限.

Objectives: Patients underwent pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to investigate the effect of thrombus distribution on the occurrence of severe reperfusion pulmonary edema (RPE) and identify specific parameters for predicting severe RPE. Methods: Patients with CTEPH who underwent PEA surgery were retrospectively analyzed. The thrombus in pulmonary arteries were evaluated through computed tomography pulmonary angiography. Based on presence of prolonged artificial ventilation, extracorporeal membrane oxygenation required, or perioperative death due to RPE, the patients were divided into the severe RPE and without severe RPE groups. Main results: Among the 77 patients (29 women), 16 (20.8%) patients developed severe RPE. The right major pulmonary artery (RPA) (0.64[0.58, 0.73] vs 0.58[0.49, 0.64]; p = 0.008) and pulmonary artery trunk (PAT) thrombus ratios (0.48[0.44, 0.61] vs 0.42[0.39, 0.50]; p = 0.009) (the PAT ratio is expressed as the sum of the right middle lobe clot burden and right lower lobe clot burden divided by the total clot burden multiplied by 100) of the severe RPE group was significantly higher than that of the without severe RPE group. Receiver operator characteristics curve identified a PAT ratio of 43.4% as the threshold with areas under the curve = 0.71(95%CI 0.582; 0.841) for the development of severe RPE (sensitivity 0.875, specificity 0.541). The logistic regression analysis demonstrated that age, period from symptom onset to PEA, NT-pro BNP, preoperative mPAP, preoperative PVR, RPA ratio, and PAT ratio were associated with the development of severe RPE. Multivariable logistic regression analysis revealed PAT ratio (odds ratio = 10.2; 95% confidence interval 1.87, 55.53, P = 0.007) and period from symptom onset to PEA (OR = 1.01; 95% CI = 1.00-1.02, P = 0.015) as independent risk factors for the development of severe RPE. Conclusions: The thrombus distribution could be a key factor in the severity of RPE. PAT ratio and medical history could predict the development of severe RPE. & COPY; 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

PURPOSE:Our goal was to study both right and left ventricular blood flow in patients with precapillary pulmonary hypertension (pre-PH) with 4-dimensional (4D) flow magnetic resonance imaging (MRI) and to analyze their correlation with cardiac functional metrics on cardiovascular magnetic resonance (CMR) and hemodynamics from right heart catheterization (RHC). MATERIALS AND METHODS:129 patients (64 females, mean age 47 ± 13 y) including 105 patients with pre-PH (54 females, mean age 49 ± 13 y) and 24 patients without PH (10 females, mean age 40 ± 12 y) were retrospectively included. All patients underwent CMR and RHC within 48 hours. 4D flow MRI was acquired using a 3-dimensional retrospectively electrocardiograph-triggered, navigator-gated phase contrast sequence. Right and left ventricular flow components including the percentages of direct flow (PDF), retained inflow (PRI), delayed ejection flow (PDE), and residual volume (PRVo) were respectively quantified. The ventricular flow components between patients with pre-PH and non-PH were compared and correlations of flow components with CMR functional metrics and hemodynamics measured with RHC were analyzed. Biventricular flow components were compared between survivors and deceased patients during the perioperative period. RESULTS:Right ventricular (RV) PDF and PDE significantly correlated with RVEDV and RV ejection fraction. RV PDF negatively correlated with pulmonary arterial pressure (PAP) and pulmonary vascular resistance. When the RV PDF was <11%, the sensitivity and specificity of RV PDF for predicting mean PAP ≥25 mm Hg were 88.6% and 98.7%, respectively, with an area under the curve value of 0.95 ± 0.02. When RV PRVo was more than 42%, the sensitivity and specificity of RV PRVo for predicting mean PAP ≥25 mm Hg were 85.7% and 98.5%, respectively, with an area under the curve value of 0.95 ± 0.01. Nine patients died during the perioperative period. Biventricular PDF, RV PDE, and PRI of survivors were higher than nonsurvivors whereas RV PRVo increased in deceased patients. CONCLUSIONS:Biventricular flow analysis with 4D flow MRI provides comprehensive information about the severity and cardiac remodeling of PH and may be a predictor of perioperative death of patients with pre-PH.

PurposeThis study aimed to construct a radiomics signature of epicardial adipose tissue for predicting postoperative atrial fibrillation (POAF) after pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH).MethodsWe reviewed the preoperative computed tomography pulmonary angiography images of CTEPH patients who underwent PEA at our institution between December 2016 and May 2022. Patients were divided into training/validation and testing cohorts by stratified random sampling in a ratio of 7:3. Radiomics features were selected by using intra- and inter-class correlation coefficient, redundancy analysis, and Least Absolute Shrinkage and Selection Operator algorithm to construct the radiomics signature. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the discrimination, calibration, and clinical practicability of the radiomics signature. Two hundred-times stratified five-fold cross-validation was applied to assess the reliability and robustness of the radiomics signature.ResultsA total of 93 patients with CTEPH were included in this study, including 23 patients with POAF and 70 patients without POAF. Five of the 1,218 radiomics features were finally selected to construct the radiomics signature. The radiomics signature showed good discrimination with an AUC of 0.804 (95%CI: 0.664–0.943) in the training/validation cohort and 0.728 (95% CI: 0.503–0.953) in the testing cohorts. The average AUC of 200 times stratified five-fold cross-validation was 0.804 (95%CI: 0.801–0.806) and 0.807 (95%CI: 0.798–0.816) in the training and validation cohorts, respectively. The calibration curve showed good agreement between the predicted and actual observations. Based on the DCA, the radiomics signature was found to be clinically significant and useful.ConclusionThe radiomics signature achieved good discrimination, calibration, and clinical practicability. As a potential imaging biomarker, the radiomics signature of epicardial adipose tissue (EAT) may provide a reference for the risk assessment and individualized treatment of CTEPH patients at high risk of developing POAF after PEA.

Introduction: To determine the risk factors of hyperlactatemia in pulmonary endarterectomy (PEA) surgery and assess whether elevated blood lactate levels are associated with adverse outcomes.Methods: In this retrospective observational study, a total of 111 consecutive patients who underwent PEA for chronic thromboembolic pulmonary hypertension at the XXX Hospital between December 2016 and January 2022 were included. We retrospectively evaluated arterial blood samples analyzed intraoperatively. The pre- and intraoperative risk factors for hyperlactatemia and the postoperative outcomes were recorded.Results: Lactate levels gradually increased during surgery. The optimal cut-off lactate level for major postoperative complications, calculated using receiver operating characteristic analysis, was 7.0 mmol/L. Deep hypothermic circulatory arrest (DHCA) duration, nadir hematocrit, and preoperative pulmonary vascular resistance were risk factors for lactate levels >7 mmol/L. Moreover, the intraoperative peak lactate level during PEA under DHCA was found to be a statistically significant predictor of major complications being associated with longer mechanical ventilation time (r = 0.294; p = .003) and intensive care unit length of stay (r = 0.327; p = .001).Conclusions: Deep hypothermic circulatory arrest duration, nadir hematocrit, and preoperative pulmonary vascular resistance were associated with hyperlactatemia. Increased lactate levels were independent predictors of longer mechanical ventilation time, intensive care unit length of stay, and major complications.