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Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa
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 cha...
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| Format: | Thesis |
| Language: | Eng |
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Department of Medicine
2024
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| _version_ | 1867613300540309504 |
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| access_status_str | Open Access |
| author | Davies-Van, Es Sophie |
| author2 | Calligaro, Gregory |
| author_browse | Calligaro, Gregory Davies-Van, Es Sophie |
| author_facet | Calligaro, Gregory Davies-Van, Es Sophie |
| author_sort | Davies-Van, Es Sophie |
| collection | Thesis |
| description | 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). |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/39350 |
| institution | University of Cape Town (South Africa) |
| language | Eng |
| last_indexed | 2026-06-10T12:33:57.504Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2024 |
| publishDateRange | 2024 |
| publishDateSort | 2024 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/39350 Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa Davies-Van, Es Sophie Calligaro, Gregory Symons Gregory Health science 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). 2024-04-11T13:05:02Z 2024-04-11T13:05:02Z 2023 2024-04-08T12:02:28Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/39350 Eng application/pdf Department of Medicine Faculty of Health Sciences |
| spellingShingle | Health science Davies-Van, Es Sophie Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa |
| thesis_degree_str | Master's |
| title | Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa |
| title_full | Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa |
| title_fullStr | Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa |
| title_full_unstemmed | Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa |
| title_short | Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa |
| title_sort | pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in cape town south africa |
| topic | Health science |
| url | http://hdl.handle.net/11427/39350 |
| work_keys_str_mv | AT daviesvanessophie pulmonaryendarterectomyforchronicthromboembolicpulmonaryhypertensionincapetownsouthafrica |