AIRWAY HEMORRHAGE AFTER PULMONARY THROMBOENDARTERECTOMY: RISK FACTORS AND OUTCOMES

Abstract

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Airway hemorrhage is a rare but potentially fatal complication of pulmonary thromboendarterectomy (PTE) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) that may require aggressive management, including bronchial blocker or extracorporeal membrane oxygenation (ECMO). Predisposing factors for postoperative airway hemorrhage have not been well described. The aims of this study were to assess risk factors and postoperative outcomes for subjects with CTEPH who develop post-PTE airway hemorrhage. METHODS: This was a retrospective chart review of subjects undergoing PTE from January 2015 to December 2019. Postoperative airway hemorrhage (Postop-H) was defined as significant endobronchial bleeding requiring withholding anticoagulation, bronchial blocker and/or ECMO. Data on Postop-H and control subjects (PTE subjects without airway hemorrhage) including demographics, preoperative medications and hemodynamics, intraoperative course and postoperative outcomes were collected. RESULTS: 877 subjects underwent PTE of which 59 subjects (6.7%) developed Postop-H. Subjects with Postop-H were more likely to be female (61% vs. 45%, p=0.02), had significantly higher mean age (57.9+/-15.0 vs. 54.0+/-15.5 years, p=0.04) and a higher incidence of preoperative hemoptysis (18.6% vs. 7.6%, p=0.007) compared to the controls. There was no significant difference in the use of preoperative pulmonary hypertension (PH) therapy between groups. Preoperative hemodynamics were worse in the Postop-H vs. control subjects, with higher mean right atrial pressure (11.6+/-5.5 vs. 9.7+/-5.8mmHg, p=0.007), mean pulmonary artery pressure (44.4+/-9.5 vs. 40.8+/-12.6mmHg, p=0.02) and pulmonary vascular resistance (PVR) (726.2+/-374.0 vs. 565.4+/-342.5dyn*s*cm-5, p=0.0003), and lower cardiac index (2.1+/-0.5 vs. 2.4+/-0.6L/min/m2, p=0.0004). Compared to controls, Postop-H subjects had significantly greater distal disease burden as assessed by UCSD level of clot (39% vs. 27%, p=0.05) and were more likely to have residual PH (PVR >400dyn*s*cm-5) (17.0% vs. 6.5%, p=0.004). Treatment of Postop-H required bronchial blocker and ECMO in 2 (3.4%) subjects, bronchial blocker without ECMO in 26 (44.1%) subjects, and solely holding postoperative anticoagulation in 31 (52.5%) subjects. Mortality was seen in 8 (13.6%) Postop-H subjects and 10 (1.2%) controls (p=<0.0001). CONCLUSIONS: CTEPH subjects undergoing PTE who developed postoperative airway hemorrhage were older, more likely to be female and have preoperative hemoptysis, had worse preoperative hemodynamics and had more distal disease compared to those without Postop-H. Postoperative airway hemorrhage is associated with a higher incidence of residual pulmonary hypertension and higher mortality. CLINICAL IMPLICATIONS: These risk factors may assist clinicians in identifying CTPEH patients who are at higher risk of developing postoperative airway hemorrhage after PTE in the future. DISCLOSURES: No relevant relationships by Timothy Fernandes, source=Web Response No relevant relationships by Alisha Kabadi, source=Web Response research support relationship with Bayer HealthCare Please note: >$100000 Added 05/21/2020 by Kim Kerr, source=Web Response, value=Grant/Research Support Consultant relationship with Actelion Please note: $1001 - $5000 Added 05/21/2020 by Kim Kerr, source=Web Response, value=Consulting fee Consultant relationship with Actelion Please note: $5001 - $20000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Consulting fee Consultant relationship with Bayer Please note: $5001 - $20000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Actelion Please note: $1001 - $5000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Bayer Please note: $1001 - $5000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Honoraria Scientific Medical Advisor relationship with Gossamer Bio Please note: $5001 - $20000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Grant/Research Support Scientific Medical Advisor relationship with Sonivie Please note: $5001 - $20000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Grant/Research Support Scientific Medical Advisor relationship with United Therapeutics Please note: $1001 - $5000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Consulting fee Scientific Medical Advisor relationship with United Therapeutics Please note: $1001 - $5000 Added 05/20/2020 by Nick Kim, source=Web Response, value=Consulting fee Removed 05/20/2020 by Nick Kim, source=Web Response No relevant relationships by Michael Madani, source=Web Response Consultant relationship with Actelion LLC Please note: $20001 - $100000 Added 05/29/2020 by Demosthenes Papamatheakis, source=Web Response, value=Honoraria Principal Investigator relationship with Actelion Please note: $1-$1000 Added 05/30/2020 by David Poch, source=Web Response, value=No compensation Principal Investigator relationship with United Therapeutics Please note: $1-$1000 Added 05/30/2020 by David Poch, source=Web Response, value=No compensation Principal Investigator relationship with Reatta Please note: $1-$1000 Added 05/30/2020 by David Poch, source=Web Response, value=No compensation Principal Investigator relationship with Phasebio Please note: $1-$1000 Added 05/30/2020 by David Poch, source=Web Response, value=No compensation Principal Investigator relationship with Acceleron Please note: $1-$1000 Added 05/30/2020 by David Poch, source=Web Response, value=No compensation No relevant relationships by Victor Pretorius, source=Web Response