经皮腔内肺动脉成形术治疗慢性血栓栓塞性肺动脉高压的有效性及安全性评估

目的评估经皮腔内肺动脉成形术(PTPA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)患者的有效性和安全性。方法该研究为前瞻性单臂试验。纳入2017年1月至2019年6月武汉亚洲心脏病医院心外科确诊的CTEPH患者。以明确诊断CTEPH的时间为基线, 收集入选患者的基线临床资料, 包括年龄、性别、世界卫生组织(WHO)功能分级、6 min步行距离、N末端B型利钠肽原(NT-proBNP)水平以及右心导管测定的血流动力学指标等。患者分次行PTPA, 统计每位患者扩张血管数, 术后24周随访并复查右心导管。记录手术安全性指标, 包括全因死亡、围术期并发症、再灌注肺水肿等。结果共入选患者19例, 年龄(56.3±12.5)岁, 男性7例。入选患者分别进行了1～7次PTPA, 总计56次, 累计扩张肺动脉260支, 每次扩张血管(5.14±2.36)支。共13例患者测定了6 min步行距离, 为(307±130)m。入选患者PTPA术后均自述体力明显改善, 尤其以第一次手术后为著。PTPA术后24周, 入选患者平均肺动脉压由基线的(40.11±7.55)mmHg(1 mmHg=0.133 kPa)...     

球囊肺动脉成形术治疗肺动脉血栓内膜剥脱术后残余/复发肺动脉高压的疗效和安全性研究

目的:对球囊肺动脉成形术(BPA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)患者肺动脉血栓内膜剥脱术(PEA)术后残余/复发肺动脉高压的有效性和安全性进行评估。方法:本研究为单中心病例对照研究。采用非随机抽样的方法纳入2004年11月至2021年12月于首都医科大学附属北京朝阳医院行PEA的CTEPH患者76例,其中发...     

慢性血栓栓塞性肺动脉高压的误诊分析

慢性血栓栓塞性肺动脉高压(CTEPH)是指肺动脉及其主要分支由于血栓栓塞导致的血流受阻,长期不能缓解或进行性加重,导致肺动脉高压。CTEPH的误诊率很高,笔者对近3年所收治的7例CHEPH患者进行误诊分析,以提高对CTEPH的认识。1对象与方法近3年我院心内科确诊的CTEPH患者共7例,男2例,女5例。年龄40~66(52±9.52)岁。均经螺旋CT肺血管造影(CTPA)和肺通气灌注扫描证实的至少有1个肺段以上的肺栓塞。患者均经过超声多普勒检测肺动脉收缩压>30mmHg(1mmHg=0·133kPa)以上,均排除其他非血栓栓塞性肺动脉高压。2结果症状体征:主要症状有…     

《中国肺动脉高压诊断与治疗指南(2021版)》解读：慢性血栓栓塞性肺动脉高压

慢性血栓栓塞性肺动脉高压(CTEPH)是一种急性肺血栓栓塞症的远期并发症。2021年1月,《中国肺动脉高压诊断与治疗指南(2021版)》发布,将CTEPH作为单独章节,从CTEPH早期识别、诊断及治疗三个方面出发,明确了如何利用影像学检查早期识别CTEPH,提出了肺动脉血栓内膜剥脱术、靶向药物治疗、球囊肺动脉成形术的适...     

老年瓣膜病合并重度肺动脉高压行瓣膜手术的疗效

目的分析老年瓣膜病合并重度肺动脉高压行瓣膜手术的疗效。方法回顾性分析该院2012年1月至2015年4月收治的瓣膜病合并重度肺动脉高压患者242例(肺动脉收缩压70 mm Hg),分为老年组(年龄≥60岁,n=104)和非老年组(年龄60岁,n=138),对体外循环转流时间、阻断时间、呼吸机辅助时间和ICU监护时间进行分析,以手术前和术后肺动脉收缩压(PASP)、左心室射血分数(LVEF)和死亡率等作为疗效观察指标,评价两组患者的疗效。结果两组体外循环时间、阻断时间相比无明显差异(P0.05);老年组呼吸机辅助时间及监护室时间较非老年组略有增加,但无统计学差异(P0.05)。瓣膜置换或修复后,两组手术前后肺动脉压力比较未见明显差异(P0.05);老年组LVEF手术后由(58.7±7.3)%变为(57.9±8.6)%,非老年组由(60.0±5.5)%变为(59.2±6.4)%略有下降,同组前后比较及两组之间比较均无统计学意义(P0.05)。两组死亡率比较差异无统计学意义(P0.05)。结论心脏瓣膜病合并重度肺动脉高压行瓣膜手术治疗后肺动脉压力均明显下降,心功能维持术前水平,经过严密的处理,疗效及死亡率与年龄无明显相关。     

球囊肺动脉成形术治疗肺动脉血栓内膜剥脱术后残余/复发肺动脉高压的疗效和安全性研究

目的对球囊肺动脉成形术(BPA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)患者肺动脉血栓内膜剥脱术(PEA)术后残余/复发肺动脉高压的有效性和安全性进行评估。方法本研究为单中心病例对照研究。采用非随机抽样的方法纳入2004年11月至2021年12月于首都医科大学附属北京朝阳医院行PEA的CTEPH患者76例, 其中发生PEA术后残余/复发肺动脉高压的患者17例, 9例采用BPA治疗。收集患者基线资料、PEA及BPA前后平均肺动脉压(mPAP)、肺血管阻力(PVR), 超声心动图、WHO功能分级、N末端脑钠肽前体等数据, 并在末次BPA后进行至少6个月的随访。采用SPSS 26.0对数据进行统计分析。结果 PEA术后残余/复发性肺动脉高压发生率为22.4%(17/76)。9例残余/复发肺动脉高压患者在PEA术后进行了BPA治疗, 其中男6例, 女3例;年龄(52.6±10.8)岁, 年龄范围为36～71岁。PEA术后与BPA治疗前的间隔时间为(54.9±64.5)个月, 进行BPA次数为(2.7±1.1)次。末次BPA后与首次BPA治疗前相比, mPAP从(41.1±9.1) mmHg降...     

闭塞性肺动脉高压的血流动力学和急性药物试验

目的:研究闭寒性肺动脉高压,主要是慢性血栓栓塞性肺动脉高压(CTEPH)和原(特)发性肺动脉高压(PPH)的血流动力学特点和急性中西药物试验反应.方法:上世纪80年代对我院CTEPH患者46例(CTEPH组),PPH患者69例(PPH组)观察了右心导管术血流动力学变化,2组中对49例做了吸纯氧,21例舌下含服硝苯地平20 mg,18例中心静脉推注川芎嗪80 mg等急性药物试验.结果:82.60%(95/115)的患者诊断时已有中、重度[肺动脉平均压＞40 mmHg(1 mmHg=0.133 kPa)]肺动脉高压,56.52%(65/115)合并右心功能不全.PPH组肺动脉压(收缩压、舒张压及平均压)、心脏指数均高于CTEPH组,差异有统计学意义(P＜0.05～0.001).而体动脉收缩压CTEPH组高于PPH组,差异有统计学意义(P＜0.05).76%(37/49)吸氧患者肺动脉压下降,7例出现矛盾性升高,CTEPH组尤为明显(5例).硝苯地平仅19%(4/21)有选择性扩张肺循环作用,部分患者副作用较明显.川芎嗪对肺循环降压作用轻微,副作用也较少.结论:我院就诊的闭塞性肺动脉高压患者绝大多数已属中、晚期,不可避免地会影响其治疗与预后.硝苯地平作为急性药物试验药物副反应较大,不宜应用,川芎嗪未显示对肺循环有良好的降压作用,副作用也较少.     

慢性血栓栓塞性肺动脉高压:构建动物模型的研究进展

慢性血栓栓塞性肺动脉高压(CTEPH)被认为是急性肺血栓栓塞症的一种长期并发症,然而,研究表明,部分确诊为CTEPH的患者并无症状性肺血栓栓塞的既往病史,提示肺血栓栓塞可能并不是CTEPH的唯一病因.尽管近年来对肺动脉高压的研究取得了广泛的进展,但由于缺乏对CTEPH病理生理学的相关研究,此类患者的综合治疗仍面临许多挑...     

慢性血栓栓塞性肺动脉高压的介入治疗

慢性血栓栓塞性肺动脉高压(CTEPH)是肺栓塞的潜在致命结果。目前肺动脉内膜剥脱术(PEA是首选的治疗方法,但多种因素限制了其临床应用和开展。对于不能行PEA治疗的CTEPH患者,经皮球囊肺动脉成形术是近年来发展迅速的一种能够改善患者临床症状、降低肺动脉压力和肺血管阻力并改善患者预后的新的介入治疗方法。     

不同类型肺动脉高压临床特点分析

目的研究特发性肺动脉高压(IPAH)、慢性血栓栓塞性肺动脉高压(CTEPH)和结缔组织疾病相关肺动脉高压(CTD-PAH)的临床特点。方法回顾性分析北京协和医院1997年1月至2004年9月诊断为IPAH、CTEPH、CTD-PAH住院患者的临床资料。结果 IPAH、CTEPH、CTD-PAH3组患者女/男的比例分别为14/4、6/10、77/5(P0.01);平均年龄分别为37岁、51岁、41岁(P=0.022)。出现呼吸困难比例分别为100%、100%、84.1%(P=0.008);发生肢端雷诺征分别为5.56%、0、56.1%(P0.01)。超声心动图肺动脉收缩压分别为(87.38±21.52)mmHg、(89.63±18.39)mmHg、(69.89±21.07)mmHg(P0.01);并发间质性肺疾病的比例分别为5.56%、0和35.4%(P0.01)。结论 IPAH和CTD-PAH患者以青中年女性为主,而CTEPH患者则中年男性多见。IPAH和CTEPH组患者超声心动图肺动脉收缩压高于CTD-PAH组,而CTD-PAH患者则肢端雷诺现象明显,更易并发间质性肺疾病。     

Role of NT-proBNP and 6MWD in chronic thromboembolic pulmonary hypertension

BACKGROUND: This study aims to evaluate the role of NT-proBNP and six minute walking distance (6MWD) in the pre- and post-operative assessment of subjects undergoing pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: Subjects undergoing PEA between August 2004 and July 2006 were assessed at baseline and 3 months post-operatively with resting haemodynamics, NT-proBNP and 6MWD. RESULTS: A number of 111 subjects underwent surgery, of which 102 were included. 15 subjects died before their 3 month assessment. Non-survivors had significantly worse preoperative NT-proBNP and 6MWD (4728 pg/mL vs 1863 pg/mL, p=0.001, 182.4 m vs 263.5 m, p=0.001). Taking pre-operative cut-off values of 1200 pg/mL for NT-proBNP and 345 m for 6MWD, both tests had high negative predictive value for predicting mortality (97.3% and 100%, respectively). Amongst survivors, peri-operative changes in NT-proBNP and 6MWD correlated with changes in total pulmonary resistance (TPR) (r=0.49, p<0.001 and r=-0.46, p<0.001). Post-operatively, both NT-proBNP and 6MWD also correlated with mPAP (r=0.65, p<0.001 and r=-0.50, p<0.001) and PVR (r=0.63, p<0.001 and r=-0.47, p<0.001). The ability of NT-proBNP to predict persistent pulmonary hypertension was significantly confounded by age, but not gender, BMI or renal function. CONCLUSIONS: Pre-operative evaluation with NT-proBNP and 6MWD helps risk-stratify patients prior to PEA. Post-operatively, both markers correlate with changes in disease burden and right ventricular function. These results suggest that both NT-proBNP and 6MWD offer effective 'bedside' tools for the long term follow up of patients with CTEPH.     

肺动脉血栓内膜剥脱术治疗慢性栓塞性肺动脉高压效果分析

目的分析慢性栓塞性肺动脉高压(CTEPH)患者应用肺动脉血栓内膜剥脱术(PTE)治疗的围手术期及中、晚期效果。方法选择CTEPH患者81例,按临床病理分型分为中央型组60例和外周型组21例,在深低温停循环下行PTE,随访5年,观察生存率。回顾性按年龄将患者分为老年组(≥60岁,19例)和非老年组(<60岁,62例),比较2组早期及晚期生存率。结果中央型组围手术期死亡1例。外周型组患者体外循环时间、主动脉阻断时间、深低温停循环时间均显著长于中央型组;围手术期肺动脉高压危象发生率显著高于中央型组,肺再灌注损伤发生率显著低于中央型组;肺动脉收缩压、肺循环阻力显著高于中央型组(P<0.05,P<0.01)。随访期间1例死亡,5年生存率为98.77%。老年组与非老年组术后早期及晚期生存率差异无统计学意义(P>0.05)。结论 PTE治疗CTEPH患者有较好的围手术期及中、晚期生存率,老年患者术后早期及晚期生存率与非老年患者无显著差异。术前准确评估,可提高PTE早期及中、晚期生存率。     

Long-term use of sildenafil in inoperable chronic thromboembolic pulmonary hypertension

BACKGROUND: There are currently no licensed medical therapies for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: In this double-blind, placebo-controlled pilot study, 19 subjects with inoperable CTEPH were randomly assigned to sildenafil or placebo for 12 weeks. The primary end point was change in 6-min walking distance (6MWD). Secondary end points included changes in World Health Organization (WHO) class, cardiopulmonary hemodynamics, quality of life (QOL) scores, and N-terminal pro brain natriuretic peptide (NT-proBNP). All subjects were transferred to open-label sildenafil at the end of the study and offered repeat assessment at 12 months. RESULTS: There were no significant differences between the two groups with respect to change in exercise capacity. However significant improvements were seen in WHO class and pulmonary vascular resistance (PVR). Seventeen subjects were eligible for reassessment at 12 months and demonstrated significant improvements in 6MWD, activity and symptom components of QOL, cardiac index, PVR, and NT-proBNP. CONCLUSIONS: Although this pilot study was insufficiently powered to test the primary end point, it did suggest beneficial effects in favor of sildenafil in several secondary end points at both 3 months and 12 months. Further larger-scale trials of sildenafil in inoperable CTEPH are required to confirm these findings and potentially increase the treatment options available for this devastating disease. TRIAL REGISTRATION: The study protocol was registered with the UK National Research Register database (publication ID N0542136603).     

Safety and efficacy of percutaneous transluminal pulmonary angioplasty in elderly patients

Background

Percutaneous transluminal pulmonary angioplasty (PTPA) is a recently developed catheter-based therapy for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of the present study was to investigate the safety and efficacy of PTPA in elderly patients with CTEPH.

Methods

In all, 257 PTPA sessions in 70 patients (median age 63 years) were analyzed. Patients were divided into two groups according to age: (i) a younger group (< 65 years; n = 39); and (ii) an elderly group (≥ 65 years; n = 31).

Results

Hemodynamic improvements were comparable between the younger and elderly groups (63.1% vs. 68.2% decrease in pulmonary vascular resistance, respectively; P > 0.05). The median length of stay in the intensive care unit after each session (1.0 vs. 1.0 days) and in hospital per session (9.2 vs. 9.4 days) was similar between the two groups (P > 0.05 for all). The prevalence of reperfusion pulmonary edema (23.4% vs. 26.3% across all sessions) and other complications, such as contrast dye-induced nephropathy (0% vs. 2.0%), infection (0% vs. 0%), and neurological complications (0% vs. 1.0%), was comparable in the younger vs. elderly groups (P > 0.05 for all). One-year all-cause mortality was similar in the younger and elderly groups (0% vs. 3.2%, respectively; P > 0.05).

Conclusions

PTPA can be performed safely and effectively, even in elderly patients, and could be considered as an alternative therapeutic strategy for elderly patients who are too fragile for pulmonary endarterectomy (PEA) or who are treated in institutions without highly experienced PEA surgeons.     

Segurança e eficácia da angioplastia pulmonar por balão em Portugal num centro de referência em hipertensão pulmonar

IntroductionBalloon pulmonary angioplasty (BPA) is an alternative therapy in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual/recurrent pulmonary hypertension (PH) after surgery. The aim of this study was to assess the short‐term efficacy and safety of a BPA program.MethodsThis prospective single‐center study included all BPA sessions performed in CTEPH patients between 2017 and 2019. Clinical assessment including WHO functional class, plasma biomarkers, 6‐min walk test (6MWT) and right heart catheterization was performed at baseline and six months after the last BPA session.ResultsA total of 57 BPA sessions were performed in 11 CTEPH patients (64% with inoperable disease, 82% under pulmonary vasodilator therapy). Nine patients completed both the BPA program and a minimum six‐month follow‐up period. There were significant improvements in WHO functional class (p=0.004) and 6MWT (mean increase of 42 m; p=0.050) and a trend for significant hemodynamic improvement: 25% decrease in mean pulmonary artery pressure (mPAP) (p=0.082) and 42% decrease in pulmonary vascular resistance (PVR) (p=0.056). In the group of patients with severely impaired hemodynamics (three patients with mPAP >40 mmHg), the reduction was significant: 51% in mPAP (p=0.013) and 67% in PVR (p=0.050). Prostacyclin analogs and long‐term oxygen therapy were withdrawn in all patients. Minor complications were recorded in 25% of patients. There were no major complications or deaths.ConclusionsA BPA strategy on top of pulmonary vasodilator therapy further improves symptoms, exercise capacity and hemodynamics with an acceptable risk‐benefit ratio in patients with inoperable CTEPH or residual/recurrent PH after surgery.     

涎液化糖链抗原-6在老年特发性肺纤维化诊治中的应用

目的探讨涎液化糖链抗原-6（kerbs von den lungen-6, KL-6）在老年特发性肺纤维化（idiopathic pulmonary fibrosis, IPF）诊断和治疗中的评估价值。 方法选取2018年7月至2019年11月牡丹江医学院附属红旗医院收治的普通型间质性肺炎型IPF患者68例，其中老年患者36例（老年IPF组）、非老年患者32例（非老年IPF组），另择同期老年健康体检者32例（老年健康组）作为对照。采用酶联免疫吸附试验测定血清KL-6表达水平，记录所有IPF患者的肺功能指标，并对其普通型间质性肺炎病变程度进行评估。比较各组血清KL-6的表达水平及肺部高分辨率CT（HRCT）评分，分析KL-6与肺功能指标和肺部HRCT评分的相关性。多组间的比较采用方差分析（进一步两两比较采用LSD-t检验）或秩和检验，计数资料的比较采用χ²检验；相关关系采用Pearson相关分析或Spearman秩相关分析。 结果3组患者KL-6表达水平的差异有统计学意义（F=63.425，P<0.05），其中老年IPF组明显高于非老年IPF组和老年健康组（P<0.01）。ROC曲线显示，KL-6诊断老年IPF的临界值为516.21 U/ml，此时敏感度和特异度最高，分别为94.4%和87.5%。无论是老年IPF组还是非老年IPF组，急性加重患者血清KL-6表达水平均明显高于稳定患者（t=2.843、2.215，P<0.05或0.01）；老年IPF组中急性加重患者血清KL-6表达水平均明显高于非老年IPF组（t=2.657，P<0.05）。相关分析显示，无论是68例IPF患者还是老年IPF组患者，其KL-6水平与HRCT评分均呈正相关（r=0.748、0.699，P<0.01）。老年IPF患者血清KL-6表达水平与部分限制性通气功能和弥散功能指标呈负相关（r=-0.515、-0.393、-0.384，P<0.05）。 结论血清KL-6对诊断IPF有一定临床意义，尤其对于老年患者具有较高的诊断敏感度及特异度，且与疾病严重程度及治疗效果呈现一定相关性。     

Characterization of brain natriuretic peptide in long-term follow-up of pulmonary arterial hypertension

STUDY OBJECTIVES: Pulmonary arterial hypertension (PAH) leads to substantial morbidity and mortality. Noninvasive parameters in the follow-up assessment of PAH could be helpful in clinical decision making. The brain natriuretic peptide (BNP) has been shown to correlate with the functional status and prognosis of these patients and could be a valuable parameter in this respect. The aim of our study was to investigate whether BNP levels could reflect clinical and hemodynamic changes, including the response to therapy during long-term follow-up in patients with PAH. STUDY DESIGN: We measured pulmonary hemodynamics, functional parameters including the 6-min walk distance (6MWD), and plasma BNP levels at baseline and after a mean (+/- SEM) follow-up period of 12.6 +/- 1.5 months in patients with PAH. RESULTS: In group A (n = 18), with decreasing BNP levels mean pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) decreased (PAP, 60.89 +/- 3.44 to 53.47 +/- 3.24 mm Hg; PVR, 1,207.47 +/- 111.75 to 942.35 +/- 103.15 dyne.s.cm(-5); p < 0.01) and 6MWD increased (408.24 +/- 29.57 to 470 +/- 25.54 m; p < 0.01). In group B (n = 12), with increasing BNP levels mean PAP and PVR increased (PAP, 52 +/- 3.31 to 60.17 +/- 5.03 mm Hg; PVR, 946.13 +/- 115.35 to 1,236.6 +/- 180.23 dyne . s . cm(-5); p < 0.01) and mean 6MWD decreased from 463.64 +/- 27.77 to 367.27 +/- 38.87 m (p < 0.05). Comparing groups revealed statistically significant differences regarding changes in PAP (group A, -11.58 +/- 3.57%; group B, +13.29 +/- 5.44%; p = 0.001) and PVR (group A, -19.21 +/- 5.87%, group B, +30.35 +/- 7.72%; p < 0.001). Correlations existed between the changes in BNP levels and pulmonary hemodynamics. CONCLUSION: We concluded that BNP levels parallel changes in pulmonary hemodynamics and functional parameters, including the 6MWD, in PAH patients. Consequently, we suggest BNP as a parameter for the follow-up assessment of PAH patients.     

Long-term bosentan in chronic thromboembolic pulmonary hypertension

BACKGROUND: There is no approved pharmacological treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are not suitable for pulmonary endarterectomy (PEA). OBJECTIVE: The study investigates the effect of the dual endothelin receptor antagonist bosentan on exercise tolerance (6-min walking distance, 6MWD) and right ventricular function (Tei index) in patients with CTEPH over 24 months. METHODS: Twelve consecutive patients (5 males and 7 females) with CTEPH not eligible for PEA or following partial or complete failure of PEA were included in a non-randomized, open-label prospective study. All patients were WHO class III. They were included, if progressive pulmonary hypertension was diagnosed despite best supportive treatment. Bosentan was started at 62.5 mg b.i.d. and increased to the final dose of 125 mg b.i.d. RESULTS: 6MWD and the Tei index were assessed every 6 months. We observed a significant increase in 6MWD from 319 +/- 85.0 m at baseline to 391 +/- 76.9 m at 6 months and a significant decrease in the Tei index from 0.39 +/- 0.10 at baseline to 0.34 +/- 0.08 at 6 months. This improvement was maintained over 24 months (6 MWD: 381 +/- 101 m; Tei index: 0.31 +/- 0.03). Six patients exhibited an improvement in WHO class at 6, 12 and 18 months, 5 demonstrated improvement at the 24-month follow-up. The remainder were stable throughout the study period. CONCLUSION: This is the first study demonstrating a long-term beneficial effect of bosentan on exercise tolerance (6MWD) and right heart function (Tei index) in CTEPH.     

Tratamiento médico y quirúrgico de la hipertensión pulmonar tromboembólica crónica: experiencia en un único centro

IntroductionPulmonary endarterectomy (PE) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to analyze our experience in the medical and surgical management of CTEPH.MethodsWe included 80 patients diagnosed with CTEPH between January 2000 and July 2012. Thirty two patients underwent PE and 48 received medical treatment (MT). We analyzed functional class (FC), six-minute walking distance (6MWD) and pulmonary hemodynamics. Mortality in both groups and periods were analyzed.ResultsPatients who underwent PE were younger, mostly men, and had longer 6MWD. No differences were observed in pulmonary hemodynamics or FC at diagnosis. One year after treatment, all PE patients versus 41% in MT group were at FC I-II. At follow-up, the PE group showed greater increase in 6MWD, and greater reduction in mean pulmonary arterial pressure and pulmonary vascular resistance than the MT group (P < .05). Overall survival in the MT group at 1 and 5 years was 83% and 69%, respectively. Conditional survival in patients alive 100 days post-PE at 1 and 5 years was 95% and 88%, respectively. Surgical mortality in operated patients in the first period (2000-2006) was 31,3%, and 6,3% in the second (2007-2012).ConclusionsPE provides good clinical results, and improves pulmonary hemodynamics in patients who successfully overcome the immediate postoperative period. After a learning period, the current operatory mortality in our center is similar to international standards.