Outcome after surgical treatment of chronic thromboembolic pulmonary hypertension: dealing with different patient subsets. A single-centre experience

OBJECTIVES: , this procedure is linked with an increased perioperative risk. We compare the outcomes of patients with moderate to severe versus extremely elevated PVR. METHODS: , to assess the therapeutic success regarding pulmonary pressure reduction, functional outcome and risk factors for perioperative mortality. RESULTS: were significant predictors of in-hospital mortality. The median duration of surgery was 360 min, cardiopulmonary bypass 230 min, aortic cross-clamp time 150 min and circulatory arrest 34 min. In total, there were 14 in-hospital deaths (6.5%) mainly due to right heart failure (n = 7) and multiorgan failure (n = 3). Bleeding, stroke, sepsis and pneumonia led to death in 1 patient each. Mortality was significantly higher in the two groups with PVR > 800, but absolute pressure reduction was also higher in these groups. The 1-year survival rate was 91.2%. CONCLUSIONS: Despite the increased perioperative risk and mortality, PEA should not be denied to patients with extremely elevated PVR but clear indication for surgery. Keeping increased perioperative risk and mortality in mind, significant pressure reduction and improved functional outcome can be achieved in the majority of these patients.