Supervised exercise training in patients with chronic thromboembolic pulmonary hypertension (CTEPH) as early follow-up treatment after pulmonary endarterectomy (PEA) – a prospective cohort study

Background: Safety, feasibility and effect of combined supervised inpatient rehabilitation as early follow-up treatment after pulmonary endarterectomy (PEA) has not yet been prospectively investigated in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Forty-five patients with CTEPH (49% female, 57.6 ± 12.4years, 60% WHO functional class III pre-PEA) started a 19-week rehabilitation program (3 weeks inpatient and continued at home for another 16 weeks) with supervised exercise training as follow-up treatment shortly after PEA. Haemodynamics were assessed by right heart catheterization before PEA and 22 weeks post PEA. Non-invasive assessments as transthoracic echocardiography and 6-minute walking test (6MWD) were performed before PEA and after 3 (= beginning of rehabilitation), 6- and 22-weeks post PEA. Adverse events were recorded throughout the study. Results: Rehabilitation was started 3.3 ± 0.9 weeks after PEA. Exercise training was well tolerated in all patients without severe side effects. Haemodynamics measured by right heart catheterization significantly improved from pre PEA to 22 weeks post PEA in cardiac output (+1.2 ± 1.5 l/min, equals 33.4%, p=0.001) and mean pulmonary arterial pressure (-19 ± 13 mmHg, equals -39.6%, p Conclusions: Supervised exercise training was feasible and safe as early follow-up treatment after PEA.