PEA with concomitant cardiac procedures increased in-hospital mortality (16.7% vs 3.6%) and reduced long-term survival (73.3% vs 96.4%, p=0.023) versus isolated PEA.
Does pulmonary endarterectomy combined with concomitant cardiac procedures affect clinical outcomes and survival compared to isolated pulmonary endarterectomy in patients with CTEPH?
While combined pulmonary endarterectomy and cardiac procedures provide clinical benefits, they carry significantly higher perioperative risk and lower long-term survival compared to isolated PEA, largely driven by preoperative right ventricular dysfunction.
Absolute Event Rate: 0% vs 0%
Objective. To evaluate clinical and hemodynamic outcomes of pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing additional cardiac procedures. Material and methods. Fifty-eight patients underwent surgery between 2010 and 2022. They were divided into two groups: group 1 — isolated PEA (n=28); group 2 — PEA with concomitant cardiac procedures (n=30). Central hemodynamics, echocardiography parameters and clinical status (NYHA class, 6-minute walk test) were assessed preoperatively, postoperatively, and at follow-up (median duration 23.5 months). Results. Both groups demonstrated significant improvements in hemodynamic and clinical parameters. The combined group showed higher rates of complications, longer ICU stay and inotropic support, as well as higher in-hospital mortality (16.7% vs. 3.6%). Long-term survival was significantly lower in the combined group (73.3% vs. 96.4%, p=0.023). Multivariate regression identified preoperative right ventricular echocardiographic parameters as independent predictors of mortality. Importantly, comorbidities such as atrial fibrillation, coronary artery disease, diabetes mellitus and COPD had no significant effect on survival. Conclusion. Despite increased perioperative risks, combined PEA provides substantial clinical benefits. Patients with right ventricular dysfunction require thorough preoperative assessment and prolonged postoperative monitoring.
Osadchii et al. (Wed,) reported a other. PEA with concomitant cardiac procedures increased in-hospital mortality (16.7% vs 3.6%) and reduced long-term survival (73.3% vs 96.4%, p=0.023) versus isolated PEA.