Background: Pulmonary endarterectomy (PEA) is the treatment of choice for patients with operable chronic thromboembolic pulmonary hypertension (CTEPH). However, data on success rates and outcomes in Germany are limited.
Purpose: To investigate the management and outcome of patients with operable CTEPH who underwent PEA at a large German referral centre.
Methods: Consecutive patients with operable CTEPH treated with PEA (alone or combined with balloon pulmonary angioplasty [BPA]) at a single referral centre for PEA surgery between 01/2014 and 12/2015 were studied. Information on patients who underwent PEA in Germany between 01/2014 and 12/2015 were provided from the Federal Statistical Office of Germany (OPS number 5–381.42).
Results: In Germany, 194 PEAs were performed in 2014 (in-hospital mortality rate, 6.2%) and 200 in 2015 (in-hospital mortality rate, 5.5%), respectively (data provided by the Federal Statistical Office of Germany). Of those, 253 patients (64.2%) were treated at a single PEA centre and 237 (93.7%; median age, 62 [IQR, 52–72] years; 46.0% female) included in the present study. The median time from diagnosis of CTEPH to PEA was 129 (IQR, 85–271) days.
PEA was successful in 236 patients (99.6%) with reduction of median PVR from 7.2 (IQR, 5.0–10.4; n=197) to 4.8 (IQR, 3.5–6.5; n=163; p<0.001) WU and median mean PA pressure from 43 (IQR, 34–50; n=206) to 29 (IQR, 25–33; n=171; p<0.001) mmHg. The median duration of surgery was 397 (IQR, 363–431) minutes. Periprocedural (0%) and in-hospital (2.5%) mortality rates were excellent and lower than previously reported (Figure 1). Overall, 42 patients (17.7%) had intraoperative (of those, 27 had bleeding requiring additional surgical interventions) and 60 (25.3%) postoperative complications (such as bleeding with re-thoracotomy within 48 hours in 3.0%, pericardial tamponade in 5.1% and severe reperfusion lung oedema in 9.7% requiring veno-venous ECMO in 0.8% of all patients).
Duration of surgery was the only predictor of in-hospital mortality (≥500 minutes; OR, 32.0 [95% CI, 5.5–187.6]) and also the only independent predictor of both, intraoperative (≥440 minutes; OR, 10.8 [95% CI, 4.4–26.5]) and postoperative (≥390 minutes; OR, 2.4 [95% CI, 1.1–5.7]) complications. However, only intraoperative complications independently predicted a longer median duration of surgery (≥397 minutes; OR, 5.0 [95% CI, 2.2–11.2]) while other factors (e.g. haemodynamic status or additional surgical procedures) had no influence.
During the median long-term observation period of 490 (IQR, 343–697) days, 13 of 229 patients (5.7%) died.
Conclusion: In an experienced centre with multidisciplinary diagnostic and therapeutic approaches, PEA is safe. Prognosis was not influenced by baseline characteristics, comorbidities or preoperative haemodynamic status and was mainly determined by the occurrence of intraoperative complications and the duration of surgery.