Assessing Sex-Based Differences in Survival after Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Abstract

<h3>Purpose</h3> Pulmonary thromboendarterectomy (PTE) is a definitive treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Disparities in PTE outcomes between sexes have not been well studied. <h3>Methods</h3> We retrospectively reviewed all patients who underwent PTE for CTEPH at our center from June 2009 to July 2019, tracking preoperative variables including patient age at surgery, last creatinine before surgery, ejection fraction, and sex, as well as patient mortality. We assessed differences in outcomes based on sex. Survival was estimated with Kaplan-Meier and compared using the log-rank test. Risk factors for mortality after PTE were determined with multivariable Cox proportional hazards analysis. <h3>Results</h3> Of the 235 patients that underwent PTE during the study period, 107 were male (59%) and 128 were female (41%). Male patients had a higher median age at time of surgery (59 versus 50 years, p = 0.004), and higher median preoperative creatinine (1.1 versus 0.86, p < 0.001). There was no difference in 5-year survival after PTE between male and female patients (p = 0.69, Figure 1). Patient age (HR 1.049, 95% CI [1.013-1.087], p = 0.008) was significantly associated with mortality in multivariable analysis, while sex was not (HR 0.594 for male sex, 95% CI [0.224-1.573], p = 0.29). <h3>Conclusion</h3> Sex was not associated with mortality following PTE at our center. Further study with larger sample sizes are warranted.