Ten-year outcomes of pulmonary endarterectomy in Switzerland: The Zurich experience

Pulmonary endarterectomy (PEA) is the gold standard for operable chronic thromboembolic pulmonary hypertension (CTEPH), an often underdiagnosed and undertreated disease. Before 2015, Swiss patients had limited access to PEA and were operated abroad, highlighting the need for a CTEPH center in Switzerland despite its small population. We herein summarize our 10-year PEA experience, its influence on patient outcomes, and analyze potential prognosticators for complications and long-term outcomes.

Prospectively collected records of patients with CTEPH undergoing PEA at our institution (January 2015-December 2024) were retrospectively analyzed for perioperative and long-term outcome parameters, prognosticators for complications, and hemodynamic improvement. A benchmark analysis compared our center's results with the International CTEPH Registry.

Our cohort included 141 patients with CTEPH undergoing PEA, with 85 (60.3%) male patients and a median age of 62 years (range, 51-71 years). We observed significant improvements in mean pulmonary arterial pressure (mean difference, 16.6 mm Hg; P < .0001), pulmonary vascular resistance (mean difference, 3.7 WU; P < .0001), 6-minute walk test (mean difference, 68.8 m; P < .0001), oxygen requirement (χ² = 6.3%; P = .018), New York Heart Association functional classification (rank difference statistic = -8%; P < .0001), and quality of life (Lin coefficient = 13.7 points; P = .004) after PEA. In-hospital and 90-day mortality were 2.8% (n = 4). Jamieson IV (odds ratio, 4.22; P = .039) and N-terminal pro B-type natriuretic peptide (odds ratio, 1.5; P = .039) were associated with postoperative complications. A stronger immediate postoperative decrease in mean pulmonary arterial pressure (mean difference, 0.7 mm Hg; P < .0001) and pulmonary vascular resistance (mean difference, 0.4 WU; P < .0001) predicted better long-term hemodynamic outcomes. Benchmark analysis showed comparable results with International CTEPH Registry data.

Establishing a PEA program in Switzerland enabled timely, gold standard care for patients with CTEPH. Despite being a small-volume program, outcomes were comparable with high-volume centers. N-terminal pro B-type natriuretic peptide, Jamieson IV, and initial hemodynamic improvements emerged as prognosticators, warranting prospective validation.