Long-term Outcome after Pulmonary Endarterectomy

Abstract

Rationale: There are few follow-up studies on long-term cardiopul- monary function after pulmonary endarterectomy (PEA), the oper- ation of choice for chronic thromboembolic pulmonary hyperten- sion (CTEPH). Objectives: To prospectively evaluate long-term outcome of patients with CTEPH treated with PEA. Methods: Between 1994 and 2006, 157 patients (mean age 55 yr) were treated with PEA at Pavia University Hospital. The patients were evaluated before PEA and at 3 months (n 5 132), 1 year (n 5 110), 2 years (n 5 86), 3 years (n 5 69), and 4 years (n 5 49) afterward by NYHA class, right heart hemodynamic, spirometry, carbon monox- ide transfer factor (TLCO), arterial blood gas, and treadmill incre- mental exercise test. MeasurementsandMainResults: Cumulative survival was 84%. Within 3 months, 18 patients died in-hospital and 2 had lung transplanta- tion; during long-term follow-up, 6 died, 1 had lung transplantation, and 3 had a second PEA (2.5 events per 100 person-years). NYHA class III-IV was the most important predictor of late death, lung transplant, or PEA redo (hazard ratio, 3.94). Extraordinary improve- ment in NYHA class, hemodynamic, and PaO2 were achieved in the first 3 months (P , 0.001) and persisted during follow-up; exercise tolerance progressively increased over time (P , 0.001). At 4 years, although 74% of the patients were in NYHA class I and none was in class IV, 24% had pulmonary vascular resistance greater than 500 dyne.s/cm5 or PaO2 less than 60 mm Hg; they were significantly older and were more frequently in NYHA class III-IV 3 months after surgery than the others. Conclusions: After PEA, long-term survival and cardiopulmonary function recovery is excellent in most patients.