Experience with pulmonary endarterectomy: Lessons learned across 17 years

Area of Science:

• Cardiology
• Thoracic Surgery
• Pulmonary Hypertension

Background:

• Pulmonary endarterectomy is a curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH).
• This study details a 17-year experience and management strategy for CTEPH patients undergoing pulmonary endarterectomy.

Purpose of the Study:

• To evaluate the outcomes of pulmonary endarterectomy in CTEPH patients over a 17-year period.
• To identify risk factors for in-hospital mortality and assess the impact of the procedure on patient survival and quality of life.

Main Methods:

• A single-centre retrospective study of 591 CTEPH patients who underwent pulmonary endarterectomy between 2004 and 2020.
• Analysis of patient demographics, surgical outcomes, in-hospital mortality, and long-term follow-up data.

Main Results:

• In-hospital mortality decreased by 42% over the study period, from 15.7% to 9.1%.
• Significant reductions in pulmonary artery systolic pressure and improvements in 6-minute walk test distance were observed post-surgery.
• Female gender, high pulmonary artery systolic pressure, and use of extracorporeal membrane oxygenation were identified as risk factors for mortality.

Conclusions:

• Pulmonary endarterectomy demonstrates a learning curve, with improved outcomes over time.
• High pulmonary vascular resistance is not an absolute contraindication for surgery.
• Patients experience enhanced survival and quality of life following pulmonary endarterectomy.