F-31 | Outcomes of Pulmonary Endarterectomy in Patients with Systolic Heart Failure

Pulmonary Endarterectomy (PE) is the definitive treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Patient selection for PE is complex and influenced by location of obstruction, degree of hemodynamic impairment and co-morbidities. Reduced ejection fraction is an independent risk factor for postoperative mortality, and increased venous return following the surgery can further stress the failing left heart. We aim to evaluate the difference in in-hospital outcomes among patients undergoing PE with and without systolic heart failure (SHF). We identified all admissions where PE was performed for treatment of CTEPH from the National Inpatient Sample Database from 2016-2020 using ICD-10 codes. Primary outcome was inpatient mortality. Secondary outcomes are shown in Table 1. Multivariate regression analysis was used to adjust for potential confounders. A total of 5,285 PE was performed between 2016-2020 with 955 (18.1%) admissions with co-morbid systolic heart failure. Patient characteristics were similar in both groups but patients with SHF were more likely to have hypertension, coronary artery disease, coagulopathy and Charlson Comorbidity Index. There was no difference in mortality or complications between the two groups. However, compared to those without SHF, patients with SHF had longer mean length of stay (5 days vs 6 days, p=0.009) and higher total charges (52,110 vs 43,877, p=0.001). Although lengthier hospital stays and higher total charges were observed in patients with SHF, presence of SHF does not predict unfavorable short-term outcomes in patients undergoing PE.