Impact of Preoperative Hemodynamic Values on Development of Reperfusion Edema After Pulmonary Endarterectomy

Reperfusion pulmonary edema (RPE) is a severe complication after pulmonary endarterectomy (PEA) and is associated with prolonged mechanical ventilation, organ dysfunction, and worse outcome. While residual pulmonary hypertension after PEA is associated with RPE, studies on preoperative risk factors for RPE after PEA are scarce. We investigated a potential association between preoperative hemodynamic values and development of RPE after PEA surgery. All adult CTEPH-patients who underwent PEA surgery at the Kerckhoff-Clinic Bad Nauheim, Germany, between 2018 and 2021 were included. The primary endpoint was development of postoperative RPE. Preoperative hemodynamic values and patient characteristics were compared between patients with and without RPE. Receiver Operating Characteristic curve analysis and logistic regression models were used for identification of risk factors for RPE. A total of 483 patients were included in this analysis (mean age 61 ± 13 years, 57% male). 75 patients developed postoperative RPE. ROC analysis revealed a significant discrimination for RPE by preoperative mean pulmonary artery pressure (mPAP) [AUC = 0.7, 95% CI: 0.622-0.779]. According to the Youden Index, the cut-off for preoperative mPAP was 54.5 mmHg. Multivariable logistic regression identified preoperative mPAP [OR: 2.684 95% CI: 1.220-5.904, p = 0.014] as independent risk factor for development of RPE after PEA surgery. Our study determines preoperative mPAP value as an independent risk factor for development of RPE after PEA surgery. These results might help to identify patients with an increased risk for RPE and adapt perioperative therapy accordingly.