Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension resulted in a pooled 30-day mortality of 8.4%, which significantly decreased with increasing center volume.
Systematic Review (n=9,763)
What is the early mortality and clinical outcome of pulmonary thromboendarterectomy in adult patients with chronic thromboembolic pulmonary hypertension?
Pulmonary thromboendarterectomy for CTEPH has an acceptable pooled 30-day mortality of 8.4%, with significantly better outcomes observed at higher-volume centers.
Effect estimate: 8.4% (95% CI 7.2-9.6)
Background: Pulmonary thromboendarterectomy (PTE) is the gold standard treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, the results are poorly quantified outside a few registry reports and several individual centers. Methods: A systematic review was performed searching five electronic databases assessing the outcomes for adult patients undergoing PTE for CTEPH. All articles that reported mortality data were included. Primary outcome measures were early/inpatient mortality; secondary outcomes were survival, pulmonary haemodynamics, morbidity and functional status following PTE for CTEPH. Results were pooled via a meta-analysis of proportions and meta-regression. Results: A total of 5,717 studies were identified, yielding sixty-one relevant papers. Thirty-day mortality ranged from 0.8% to 24.4%, and on meta-analysis was 8.4% 95% confidence interval (CI): 7.2-9.6%. Mortality was noted to decrease with increasing center volume of PTE cases (P<0.01). Residual pulmonary hypertension was reported in 8.2% to 44.5% of patients. Conclusions: CTEPH is associated with acceptable short-term mortality and an improvement in pulmonary hemodynamics. With increasing volume of experience and ongoing developments over time peri-operative mortality continues to decrease.
Brookes et al. (Tue,) conducted a systematic review in Chronic thromboembolic pulmonary hypertension (CTEPH) (n=9,763). Pulmonary thromboendarterectomy was evaluated on Early/inpatient mortality (8.4%, 95% CI 7.2-9.6). Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension resulted in a pooled 30-day mortality of 8.4%, which significantly decreased with increasing center volume.