Outcome after Pulmonary Endarterectomy for Segmental Chronic Thromboembolic Pulmonary Hypertension

Purpose Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). The outcome after PEA for disease located in the segmental pulmonary arteries (PA) remains unclear. Methods We reviewed 282 consecutive patients undergoing PEA in our institution between 01/2005 and 12/2017. Level of disease was defined surgically by the most proximal extension as level 1 (main PA), level 2 (lobar-interlobar PA), level 3 (proximal segmental PA), and level 4 (distal segmental-subsegmental PA). Results The proportion of patients with level 3 (n=66) and 4 (n=28) disease increased from 4% to 24% and from 0% to 16%, respectively, between 2005-2008 and 2015-2017. The proportion of females was higher in level 3 and 4 compared to level 1 and 2 (70% vs 41%, p 1,200 Dynes.s.cm −5 was higher in level 1 (38%) and 4 (39%) than in level 2 (21%) and 3 (21%) (p=0.02). Total circulatory arrest time (min) was longer in level 4 (48±16) than in level 1 (42±11), 2 (39±14) and 3 (41±15) (p=0.02). The 30-day mortality ranged between 1.3% in level 1 and 3.6% in level 4 (p=0.8). Mean PA pressures (mmHg) significantly improved postoperatively from 50±12 to 23±7 in level 1 (p 1,200 Dynes.s.cm −5 (p=0.01) were independent predictor for targeted PH therapy after PEA, while sex was not (p=0.1). Conclusion PEA in segmental disease provides significant reduction in PA pressures and is associated with excellent long-term outcomes.