Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa

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dc.contributor.advisorCalligaro, Gregory
dc.contributor.advisorSymons Gregory
dc.contributor.authorDavies-Van, Es Sophie
dc.date.accessioned2024-04-11T13:05:02Z
dc.date.available2024-04-11T13:05:02Z
dc.date.issued2023
dc.date.updated2024-04-08T12:02:28Z
dc.description.abstractIntroduction: Pulmonary endarterectomy (PEA) is the only definitive and potentially curative therapy for chronic thromboembolic pulmonary hypertension (CTEPH), associated with impressive improvements in symptoms and haemodynamics. However, it is only offered at a few centres in South Africa. The characteristics and outcomes of patients undergoing PEA in Cape Town have not been previously reported. Methods and objectives: We interrogated the Adult Cardiothoracic Surgery database at the University of Cape Town (UCT) between December 2005 and April 2021 for patients undergoing PEA at Groote Schuur Hospital and Netcare UCT Private Academic Hospital. The primary outcome was the difference in World Health Organisation (WHO) functional class (WHO-FC) before and at least 6 weeks after surgery. Results: A total of 32 patients underwent PEA: 8 patients were excluded from the final analysis due to incomplete data or a histological diagnosis other than CTEPH. The workup of these patients for surgery was variable: all had CT pulmonary angiograms, 7 (29%) had ventilation: perfusion scans, 5 (21%) underwent right heart catheterisation, and none had pulmonary angiograms. The perioperative mortality was 4/24 (17%): 1 patient (4%) had a cardiac arrest on induction of anaesthesia, 2 patients (8%) died of postoperative pulmonary haemorrhage, and 1 patient (4%) died of septic complications in the intensive care unit. In survivors, the median (IQR) improvement in WHO-FC was 2 classes (1-3, p=0.0004); 10/16 patients (63%) returned to a normal baseline (WHO-FC I). Conclusion: PEA – even in a low volume centre – is associated with significant improvements in WHO-FC and a return to normal baseline in survivors. Abstract word count: 255 KEYWORDS Chronic thromboembolic pulmonary hypertension (CTEPH), pulmonary endarterectomy (PEA), pulmonary emboli (PE), pulmonary hypertension (PH).
dc.identifier.apacitationDavies-Van, E. S. (2023). <i>Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa</i>. (). ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/39350en_ZA
dc.identifier.chicagocitationDavies-Van, Es Sophie. <i>"Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa."</i> ., ,Faculty of Health Sciences ,Department of Medicine, 2023. http://hdl.handle.net/11427/39350en_ZA
dc.identifier.citationDavies-Van, E.S. 2023. Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa. . ,Faculty of Health Sciences ,Department of Medicine. http://hdl.handle.net/11427/39350en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Davies-Van, Es Sophie AB - Introduction: Pulmonary endarterectomy (PEA) is the only definitive and potentially curative therapy for chronic thromboembolic pulmonary hypertension (CTEPH), associated with impressive improvements in symptoms and haemodynamics. However, it is only offered at a few centres in South Africa. The characteristics and outcomes of patients undergoing PEA in Cape Town have not been previously reported. Methods and objectives: We interrogated the Adult Cardiothoracic Surgery database at the University of Cape Town (UCT) between December 2005 and April 2021 for patients undergoing PEA at Groote Schuur Hospital and Netcare UCT Private Academic Hospital. The primary outcome was the difference in World Health Organisation (WHO) functional class (WHO-FC) before and at least 6 weeks after surgery. Results: A total of 32 patients underwent PEA: 8 patients were excluded from the final analysis due to incomplete data or a histological diagnosis other than CTEPH. The workup of these patients for surgery was variable: all had CT pulmonary angiograms, 7 (29%) had ventilation: perfusion scans, 5 (21%) underwent right heart catheterisation, and none had pulmonary angiograms. The perioperative mortality was 4/24 (17%): 1 patient (4%) had a cardiac arrest on induction of anaesthesia, 2 patients (8%) died of postoperative pulmonary haemorrhage, and 1 patient (4%) died of septic complications in the intensive care unit. In survivors, the median (IQR) improvement in WHO-FC was 2 classes (1-3, p=0.0004); 10/16 patients (63%) returned to a normal baseline (WHO-FC I). Conclusion: PEA – even in a low volume centre – is associated with significant improvements in WHO-FC and a return to normal baseline in survivors. Abstract word count: 255 KEYWORDS Chronic thromboembolic pulmonary hypertension (CTEPH), pulmonary endarterectomy (PEA), pulmonary emboli (PE), pulmonary hypertension (PH). DA - 2023 DB - OpenUCT DP - University of Cape Town KW - Health science LK - https://open.uct.ac.za PY - 2023 T1 - Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa TI - Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa UR - http://hdl.handle.net/11427/39350 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/39350
dc.identifier.vancouvercitationDavies-Van ES. Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa. []. ,Faculty of Health Sciences ,Department of Medicine, 2023 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/39350en_ZA
dc.language.rfc3066Eng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.subjectHealth science
dc.titlePulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMMed
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