Pulmonary Hypertension Clinical Trial
Official title:
Perioperative Transesophageal Portal Vein Pulsatility as a Predictor of Persistent Organ Dysfunction Plus Death 7 Days After Pulmonary Endarterectomy
The investigators aim to evaluate the utility of portal vein pulsatility as a predictor of the composite outcome of persistent organ dysfunction plus death in patients undergoing elective or urgent pulmonary endarterectomy for thromboembolic pulmonary hypertension. The investigators' hypothesis is that the portal vein pulsatility fraction, measured using transesophageal echocardiography immediately after weaning of cardiopulmonary bypass, is proportional to the risk of developing subsequent end-organ dysfunction in the postoperative setting.
While transesophageal echocardiography is recommended in patients with known or suspected
cardiovascular pathology which may impact outcomes, no study has evaluated it's perioperative
use in pulmonary endarterectomy surgery.
Most pulmonary endarterectomy patients suffer from severe pulmonary hypertension, right heart
dysfunction and central venous hypertension. Postoperative complications are closely related
to the importance of residual postoperative pulmonary hypertension and right ventricular
dysfunction. A portal vein pulsatility fraction of 50% or more in the perioperative setting
might indicate right ventricular dysfunction and/or hypervolemia-related severe venous
congestion, which may be responsible for multiple organ dysfunction and significant morbidity
or mortality in critically ill patients.
The investigators believe pulmonary endarterectomy patients with a high portal vein
pulsatility fraction immediately after weaning from cardiopulmonary bypass have a greater
risk of developing postoperative persistent organ dysfunction and/or death. In this
prospective descriptive study, the investigators will evaluate portal vein pulsatility as a
predictor of the composite outcome of persistent organ dysfunction plus death 7 days after
pulmonary endarterectomy.
Left and right global longitudinal strain after weaning from cardiopulmonary bypass will also
be evaluated as potential indicators of a higher risk of persistent organ dysfunction plus
death 7 days after surgery.
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