Dynamic Risk Stratification of Patient Long-Term Outcome After Pulmonary Endarterectomy: Results From the UK National Cohort
Backgrounds—Chronic thromboembolic pulmonary hypertension (CTEPH) results from incomplete resolution of pulmonary emboli. Pulmonary endarterectomy (PEA) is potentially curative, but residual PH following surgery is common and its impact on long-term outcome is poorly understood. We wanted to identify factors correlated with poor long-term outcome after surgery and specifically define clinically relevant residual PH post-PEA.
Methods and Resultss—880 consecutive patients (mean age 57 years) underwent PEA for CTEPH. Patients routinely underwent detailed re-assessment with right heart catheterisation and non-invasive testing at 3-6 months and annually thereafter with discharge if clinically stable at 3-5 years and not requiring pulmonary vasodilator therapy. Cox regressions were used for survival (time-to-event) analyses. Overall survival was 86%, 84%, 79% and 72% at 1, 3, 5 and 10 years for the whole cohort and 91% and 90% at 1 and 3 years for the recent half of the cohort. The majority of patient deaths after the peri-operative period were not due to right ventricular failure (CTEPH). At reassessment a mean pulmonary artery pressure (mPAP) ≥ 30 mmHg correlated with pulmonary vasodilator therapy initiation post-PEA. An mPAP ≥ 38 mmHg and pulmonary vascular resistance ≥ 425 dyne/sec/cm-5 at reassessment correlated with worse long-term survival.
Conclusions—Our data confirm excellent long-term survival and maintenance of good functional status post-PEA. Haemodynamic assessment 3-6 and/or 12 months post-PEA allows stratification of patients at higher risk of dying from CTEPH and identifies a level of residual pulmonary hypertension which may guide the long-term management of patients post-surgery.
- Received September 15, 2015.
- Revision received March 1, 2016.
- Accepted March 18, 2016.