Sex and survival following pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a Scandinavian observational cohort study

Abstract

<b>Background</b> Studies have suggested sex−related survival differences in chronic thromboembolic pulmonary hypertension (CTEPH). Whether long−term prognosis differs between men and women following pulmonary endarterectomy (PEA) for CTEPH remains unclear. We investigated sex−specific survival after PEA for CTEPH. <b>Methods</b> We included all patients who underwent PEA for CTEPH at two Scandinavian centers and obtained baseline characteristics and vital statuses from patient charts and national health−data registers. Propensity scores and weighting were used to account for baseline differences. Flexible parametric survival models were employed to estimate the association between sex and all−cause mortality and the absolute survival differences. The expected survival in an age-, sex-, and year of surgery matched general population was obtained from the Human Mortality Database, and the relative survival was used to estimate cause−specific mortality. <b>Results</b> A total of 444 patients were included, comprising 260 (59%) men and 184 (41%) women. Unadjusted 30−day mortality was 4.2% in men versus 9.8% in women (p=0.020). In weighted analyses, long−term survival did not differ significantly in women compared with men (HR: 1.36; 95% CI: 0.89–2.06). Relative survival at 15 years conditional on 30−day survival was 94% (79%–107%) in men versus 75% (59%–88%) in women. <b>Conclusions</b> In patients who underwent PEA for CTEPH, early mortality was higher in women compared with men. After adjustment for differences in baseline characteristics, female sex was not associated with long−term survival. However, relative survival analyses suggested 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.

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

“…Moreover, the study population was too small to evaluate possible sex differences. 30 We can only speculate about the reasons for which patients declined to participate; whether these patients were too ill to answer or were feeling well and were therefore unwilling to take the time to participate is unknown. Finally, our study results may have been affected by the COVID‐19 pandemic.…”

Sex-specific differences in sleep-disordered breathing and nocturnal hypoxemia in chronic thromboembolic pulmonary hypertension and chronic thromboembolic pulmonary disease

“…Women with CTEPH had a more adaptive RV and therefore objective signs of disease was visible later in the disease course, resulting in relatively worse outcomes for women owing to the late diagnosis ( 3 , 35 ). Another study ( 13 ) also showed sex-specific differences in cardiopulmonary function in CTEPH patients.…”

Can regional cerebral oxygen saturation monitoring during circulatory arrest time predict postoperative neurological dysfunction in patients undergoing surgical pulmonary thromboendarterectomy? Useful index for short‐ and long‐term outcomes

“…27 Currently, PTE is indicated in patients with segmental and subsegmental pulmonary artery disease with acceptable mid-and long-term results. 6,8,[12][13][14][17][18][19]21,[23][24][25] On the other hand, the balloon pulmonary angioplasty treatment for chronic PA occlusion is a novel technique for the primary treatment of CTHE and secondary treatment for residual PA thrombosis after PTE. 8,11,21,27 Brain hypoperfusion during hypothermia and CA affect brain metabolism and induce apoptosis and death of nerve cells.…”

“…Although the annual incidence of CTHE varies from 1.9 to 3–5 cases per 100,000 population, many cases with CTEPH remain undiagnosed 27 . Currently, PTE is indicated in patients with segmental and subsegmental pulmonary artery disease with acceptable mid‐ and long‐term results 6,8,12–14,17–19,21,23–25 . On the other hand, the balloon pulmonary angioplasty treatment for chronic PA occlusion is a novel technique for the primary treatment of CTHE and secondary treatment for residual PA thrombosis after PTE 8,11,21,27 …”

“…Hypothermic circulatory arrest with total arrest is an established technique for PTE in patients with CTEPH. In the last 3 years, many studies from national databases have reported outcomes after surgical PTE in literature 6–26 . A recent publication from the International Society of Heart Lung Transplantation presents the current aspects of the management and treatment of patients with CTEPH and surgical PTE 21 .…”