Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension

Abstract

Pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension. Although several reports demonstrated excellent medium-term survival after pulmonary endarterectomy, long-term outcomes remain unclear. We reviewed long-term outcomes and determined risk factors for early and late adverse events. Seventy-seven patients were studied. Mean pulmonary arterial pressure was 47±10 mm Hg and pulmonary vascular resistance was 868±319 dyne·s·cm(-5). Disease was classified as chronic thromboembolic pulmonary hypertension type 1 (n=61), type 2 (n=12), or type 3 (n=4). Median and maximum follow-up periods were 5.6 and 20 years, respectively. There were 11 in-hospital deaths. Nonsurvivors had significantly higher mean pulmonary arterial pressure and pulmonary vascular resistance than did survivors (54±10 vs 46±10 mm Hg; P=.02; 1124±303 vs 824±303 dyne·s·cm(-5); P<.01). In multivariate analysis, preoperative pulmonary vascular resistance was associated with in-hospital death (odds ratio, 1.003; 95% confidence interval, 1.001-1.005; P<.01). During follow-up, there were 10 all-cause deaths, including 5 related to chronic thromboembolic pulmonary hypertension. Freedom from adverse events, including disease-specific death or New York Heart Association functional class III, was 70% at 10 years. In the Cox proportional hazard model, postoperative mean pulmonary arterial pressure was associated with adverse events (hazard ratio, 1.12; 95% confidence interval, 1.03-1.21; P<.01). Receiver operating characteristic curve analysis showed mean pulmonary arterial pressure of 34 mm Hg as cutoff for adverse events. Pulmonary endarterectomy had sustained favorable effects on long-term survival. High pulmonary vascular resistance was associated with in-hospital death, and postoperative mean pulmonary arterial pressure was an independent predictor of adverse events.