Functional Outcomes of Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Abstract

<h3>Purpose</h3> The aim of the present study was to investigate the long-term outcomes of pulmonary thromboembolis (PEA) in patients with Chronic thromboembolic pulmonary hypertension (CTEPH), with a particular focus on identifying an effect on the improvement of functional class and right ventricular pressure. <h3>Methods</h3> Twenty-six patients underwent PEA surgery between May 2012 to April 2021. The median age was 60 ± 13.48 years, and there were more women (61.5%) than men. 9 patients (34.6%) were diagnosed with deep vein thrombosis (DVT), and 5 patients (19.2%) had cancer history. The mean ACC time for PEA was 96.88 ± 33.97 min and the mean total circulatory arrest time was 25.52 ± 10.66 minutes. Jamieson classification I was 22 patients (84.6%), II was 2 patients (7.6%), and III was 2 patients (7.6%). <h3>Results</h3> After PEA surgery, most patients (88.5%) were weaned from inotropics without extracorporeal membrane oxygenation (ECMO) support during the first few days. After surgery, 96.2% of the patients remained free of continuous renal replacement therapy. The 5-year survival rate was 95.5%, and the 5-year freedom rates of cardiac death was 100%. Our study suggests that after PEA surgery, mortality rate was low and there was marked improvement in NYHA class and health status (p<0.001, Figure) not only significantly lowered RVSP and TR grade (p<0.001, left Table). Cox univariate regression analysis demonstrated that male sex, CKD (grade III-IV), and MPA involvement were independent predictors of non-improvement after PEA surgery, according to RVSP reduction. MPA involvement remained significant predictors of non-improvement after PEA surgery in multivariate Cox regression (right Table). <h3>Conclusion</h3> Despite the increased perioperative risk and mortality, PEA could be a best choice of treatment to patients with elevated RVSP but clear indication for surgery. Furthermore, significant RV pressure reduction and improved functional outcomes can be achieved in especially non-MPA involved patients.