Long-term Outcomes After Pulmonary Endarterectomy in 499 Patients Over a 20-Year Period

Background

Pulmonary endarterectomy (PEA) is a curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary hypertension (PH) after PEA is not uncommon, and its impact on long-term outcomes is poorly understood. We investigated the effects of residual PH on current long-term survival and on postoperative status.

Methods

Data of 499 consecutive patients who underwent PEA between December 1995 and December 2014 were analyzed retrospectively. Kaplan-Meier survival analysis was used to estimate the survival rates with the 95% confidence interval.

Results

Overall survival at 5, 10, and 15 years postoperatively was 84.8% ± 1.9%, 77.1% ± 2.7%, and 59.2% ± 5.3%, respectively. Survival after discharge at 5, 10, and 15 years was 93.9% ± 1.5%, 85.4% ± 2.6%, and 65.6% ± 5.8%, respectively. Of all, 166 patients had residual PH immediately after PEA and a poorer prognosis regarding freedom from CTEPH-related death. CTEPH-related survival at 10 years in patients with normal pulmonary artery pressure vs residual PH was 89.0% ± 2.7% vs 67.9% ± 4.7%, respectively (P < .001). There was a trend to CTEPH-related survival after discharge being affected by residual PH (P = .092). At follow-up, patients with residual PH had worse exercise tolerance (P < .001) and symptoms (P < .001) compared with those with normal pulmonary artery pressure. The probability of developing PH over time was 41.9% at 15 years.

Conclusions

Survival after hospital discharge is excellent for patients undergoing PEA. Postoperative PH is associated with more symptoms and poorer functional capacity. Patients who have clinically relevant postoperative PH should be monitored closely and may be candidates for additional medical therapy.