Association of residual pulmonary hypertension with survival after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension

Abstract

This study investigated whether residual pulmonary hypertension (PH), defined as early postoperative mean pulmonary artery pressure (mPAP) of ≥30 mmHg, after undergoing pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) was associated with longterm survival. All patients who underwent PEA for CTEPH at two Scandinavian centers were included in this study. Baseline characteristics and vital statuses were obtained from patient charts and national health-data registers. The patients were then categorized based on residual PH measured via right heart catheterization within 48 h after undergoing PEA. Crude and weighted flexible parametric survival models were used to estimate the association between residual PH and all-cause mortality and to quantify absolute survival differences. From 1992 to 2020, 444 patients underwent surgery. We excluded 6 patients who died on the day of surgery and 12 patients whose early postoperative pulmonary hemodynamic data was unavailable. Of the total study population (n = 426), 174 (41%) and 252 (59%) patients had an early postoperative mPAP <30 and ≥30 mmHg, respectively. After weighting, there was a significant association between residual PH and all-cause mortality (hazard ratio: 2.49; 95% confidence interval [CI]: 1.60-3.87), and the absolute survival difference between the groups at 10 and 20 years was -22% (95% CI: -32% to -12%) and-32% (95% CI: -47% to -18%), respectively. A strong and clinically relevant association of residual PH with long-term survival after PEA for CTEPH was found. After accounting for differences in baseline characteristics, the absolute survival difference at long-term follow-up was clinically meaningful and imply careful surveillance to improve clinical outcomes in these patients. Early postoperative right heart catheter

No “great divide” in patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy?

“…In other centers, early mortality was observed to be higher in women undergoing PEA as reported from a Scandinavian observational cohort study of 444 patients. Long-term survival analysis suggested however, that the observed survival in men was close to the expected survival in the matched general population, whereas survival in women deviated notably from the matched general population [4]. This in contrast to the results of an analysis of sex-specific differences in the European CTEPH registry showing that women had a better long-term survival, irrespective of the performance or not of PEA [5].…”

Quality of life and functional status after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: A Swedish single‐center study

“…Other studies have demonstrated an association between residual PH and long‐term survival after PEA for CTEPH. 26 Furthermore, CAMPHOR scores were higher in the post‐PEA population than in propensity score‐matched patients with CTEPH who did not undergo surgery. In our study, CAMPHOR scores were obtained 5.9 years (range: 0.4–20 years) after PEA and were very similar to those in the UK cohort.…”

Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review of the Most Updated Literature

“…The correlation between residual PH and short- and long-term post-operative outcomes is also a matter of debate: a prospective study from the Cambridge group showed that the 5-year survival rate did not differ between patients with a post-operative mPAP of <30 mmHg and those with values of ≥30 mmHg [ 45 ]. Recently, some authors found a strong and clinically relevant association between residual PH and long-term survival after PEA [ 46 ]. Again, the recent ERS statement on CTEPH has acknowledged that significant residual PH is a challenge to treat early post-operatively and is the most common cause of in-hospital mortality [ 44 ].…”