Key result
In patients undergoing pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension, 10-year overall survival was 84% in those with severe disease (PVR >1,000) compared to 78% in those with PVR <1,000 (P=0.7).
Why the study?
Pulmonary endarterectomy in severe CTEPH carries higher risks, though recent evidence suggests these risks may be mitigated by ECMO use.
Does pulmonary endarterectomy yield acceptable early and long-term survival in patients with severe CTEPH (PVR >1,000 dynes.s.cm-5) compared to those with less severe disease?
Cohort (n=401)
No
Does pulmonary endarterectomy yield acceptable early and long-term survival in patients with severe CTEPH (PVR >1,000 dynes.s.cm-5) compared to those with less severe disease?
Absolute Event Rate: 84% vs 78%
p-value: p=0.7
Pulmonary endarterectomy in severe CTEPH yields excellent long-term survival, with recent improvements in hospital mortality potentially linked to increased ECMO utilization.
Supports pulmonary endarterectomy feasibility in severe CTEPH; leaves open randomized confirmation of PVR-independent survival.
Background: Pulmonary endarterectomy (PEA) in severe chronic thromboembolic pulmonary hypertension (CTEPH) is associated with higher risks. However, recent evidence suggests that these risks may be mitigated with the use of extracorporeal membrane oxygenation (ECMO). Methods: We performed a retrospective analysis of 401 consecutive patients undergoing PEA at the Toronto General Hospital between August 2005 and March 2020. Patients with severe CTEPH defined by pulmonary vascular resistance (PVR) >1,000 dynes.s.cm –5 at the time of diagnosis were compared to those with PVR <1,000 dynes.s.cm –5 . Results: The New York Heart Association (NYHA) functional class, brain natriuretic peptide (BNP) and 6-minute walk distance were worse in patients with PVR >1,000 dynes.s.cm –5 . A greater proportion of patients with PVR >1,000 dynes.s.cm –5 was treated with targeted pulmonary hypertension (PH) medical therapy (38% vs. 18%, P<0.001) and initiated on inotropic support (7% vs. 0.3%, P<0.001) before PEA. Since 2014, the ECMO utilization rate increased in patients with PVR >1,000 dynes.s.cm –5 compared to those with PVR <1,000 dynes.s.cm –5 (18% vs. 3.1%, P<0.001). The hospital mortality in patients with PVR >1,000 dynes.s.cm –5 decreased from 10.3% in 2005–2013 to 1.6% in 2014–2020 (P=0.05), while the hospital mortality in patients with PVR <1,000 dynes.s.cm –5 remained stable (1.2% in 2005–2013 vs. 2.7% in 2014–2020, P=0.4). The overall survival reached 84% at 10 years in patients with PVR >1,000 dynes.s.cm –5 compared to 78% in patients with PVR <1,000 dynes.s.cm –5 (P=0.7). Conclusions: The early and long-term results of PEA in patients with severe CTEPH are excellent despite greater postoperative risks. ECMO as a bridge to recovery after PEA can be useful in patients with severe CTEPH.
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Perrot et al. (2022) conducted a cohort in Chronic thromboembolic pulmonary hypertension (n=401). Preoperative pulmonary vascular resistance >1,000 dynes.s.cm-5 vs. Preoperative pulmonary vascular resistance <1,000 dynes.s.cm-5 was evaluated on 10-year overall survival (p=0.7). In patients undergoing pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension, 10-year overall survival was 84% in those with severe disease (PVR >1,000) compared to 78% in those with PVR <1,000 (P=0.7).
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