Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension

Objectives Pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension. Although several reports demonstrated excellent medium-term survival after pulmonary endarterectomy, long-term outcomes remain unclear. We reviewed long-term outcomes and determined risk factors for early and late adverse events. Methods Seventy-seven patients were studied. Mean pulmonary arterial pressure was 47 ± 10 mm Hg and pulmonary vascular resistance was 868 ± 319 dyne · s · cm −5 . Disease was classified as chronic thromboembolic pulmonary hypertension type 1 (n = 61), type 2 (n = 12), or type 3 (n = 4). Median and maximum follow-up periods were 5.6 and 20 years, respectively. Results There were 11 in-hospital deaths. Nonsurvivors had significantly higher mean pulmonary arterial pressure and pulmonary vascular resistance than did survivors (54 ± 10 vs 46 ± 10 mm Hg; P  = .02; 1124 ± 303 vs 824 ± 303 dyne · s · cm −5 ; P P P Conclusions Pulmonary endarterectomy had sustained favorable effects on long-term survival. High pulmonary vascular resistance was associated with in-hospital death, and postoperative mean pulmonary arterial pressure was an independent predictor of adverse events.