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A3792 - Mediastinal Granuloma as a Risk Factor for Patients Undergoing Pulmonary Endarterectomy
Author Block: E. H. Pratt1, M. E. Pugh2, I. M. Robbins3, M. Petracek4, A. S. Shah4, A. R. Hemnes1; 1Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States, 2Vanderbilt Univ Med Ctr, Nashville, TN, United States, 3Vanderbilt Univ Ctr for Lung Rsch, Nashville, TN, United States, 4Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.
Rationale: Chronic thromboembolic pulmonary hypertension (CTEPH) is unique amongst causes of pulmonary hypertension in that a surgical procedure, pulmonary endarterectomy (PEA), can normalize pulmonary arterial pressures and reduce or eliminate symptoms of right heart failure. However, PEA is a major surgical intervention that carries substantial risk for morbidity and mortality. Due to these risks, identifying appropriate operative candidates based on underlying risk factors is paramount in selecting appropriate patients for PEA. Mediastinal granuloma (MG) represents chronic granulomatous inflammation due to histoplasmosis infection, which is endemic across much of the southeastern United States. We sought to define the prevalence of MG in CTEPH patients in an endemic area and hypothesized that patients undergoing PEA with pre-existing mediastinal granuloma would be at increased risk of intraoperative complications and poorer long-term outcomes due to the presence of chronic inflammation within the surgical field. Methods: In this retrospective chart review study, we identified patients seen in our Pulmonary Hypertension Clinic who had a known or suspected diagnosis of CTEPH and who were evaluated for PEA. Available chest CT images for all patients were reviewed for the presence of MG, which was defined as a calcified nodule within the mediastinum or hilum. For patients who underwent PEA, baseline characteristics including age, sex, and comorbidities, as well as intraoperative death, postoperative time to discharge, and in hospital mortality. Results: 88 of 121 patients seen in our Pulmonary Hypertension Clinic for CTEPH underwent PEA. Mediastinal granuloma on chest CT was identified in 18/88 (20%) of patients. When comparing patients with mediastinal granuloma to patients without mediastinal granuloma, there were no differences in sex (67% female vs. 69% female) or age at time of surgery (52.0±16 years vs. 50.3±17 years). There were no intraoperative deaths recorded in either group, and there were also no differences in in hospital mortality (6.3% vs. 6.7%) or length of postoperative stay (10.5±4.9 days vs. 12.3±1.3 days). Conclusions: MG is a common finding at a southeastern US CTEPH referral center but its presence was not associated with differences in hospital mortality or length of stay. Further study is warranted to determine if the presence of MG alters hemodynamic surgical outcomes and major bleeding complications.