Pulmonary Endarterectomy: Risk Factors for Early and Late Mortality

Background Pulmonary endarterectomy is a potentially curative treatment option for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to identify predictors of short- and long-term outcomes after pulmonary endarterectomy for CTEPH patients, including age. Methods Patients who underwent surgery between March 2014 and January 2024 were included in the study. Perioperative and follow-up data were retrospectively studied, including age, in-hospital mortality, one- and five-year survival, and the length of intensive care unit and hospital stays after pulmonary endarterectomy. Results In total, 834 consecutive patients (mean age 51±15.3 years) underwent pulmonary endarterectomy and were included in the analysis. The in-hospital mortality rate was 7.8% (n = 65), while overall mortality rates at one and five years were 10.6% and 11.3%, respectively. The in-hospital mortality rate was 6.7% for patients < 70 years compared to 12.4% for patients ≥70 years (p=0.029). In the multivariate analysis of mortality, age (p=0.007), and length of intensive care unit stay (p= 0.028) emerged as independent predictors of in-hospital mortality, while the Charlson Comorbidity Index (p<0.001) and six-minute walk distance (p=0.005) were also significant predictors of one-year survival. Conclusion Despite higher short-term mortality rates, pulmonary endarterectomy was feasible and well tolerated among elderly patients. Despite surgical advancements, careful patient selection remains crucial, particularly in the presence of comorbidities. Significant clinical and hemodynamic improvements were observed, along with favorable long-term survival outcomes.