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Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a single institution experience

^a Department of Cardio-Thoracic Surgery, St Antonius Hospital, The Netherlands
^b Department of Pulmonary Diseases, St Antonius Hospital, The Netherlands

Received 3 September 2008; received in revised form 9 January 2009; accepted 13 January 2009.

^_* Corresponding author at: St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands. Tel.: +31 306092104; fax: +31 306092120. (Email: nabilio25{at}hotmail.com).

Objective: Pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is the first treatment of choice with good short-term results. Only limited data are available concerning the long-term outcome after PEA. The purpose of this study is to evaluate the long-term survival and functional outcome after PEA with nearly 10 years experience. Method: In the period of December 1998 and December 2007 120 patients with CTEPH were referred to the St Antonius Hospital (Nieuwegein, The Netherlands) of whom 72 underwent PEA. The clinical data are collected retrospectively. Results: In-hospital mortality was (5/72) 6.9%. Since 2004 one patient died in the hospital (1/38, 2.9%). Two patients died during long-term follow-up with a median observation of 3 years. The overall 1-, 3- and 5-year survival rates were 93.1%, 91.2% and 88.7% respectively. Prior to surgery patients were in New York Heart Association functional class III (58) and IV (14) with a mean pulmonary vascular resistance of 572 ± 313 dynes s cm^–5. The following data were compared before and after operation: mean pulmonary artery pressure (mPAP) decreased from 42 ± 11 to 22 ± 7 mmHg (p = 0.0001), NT-pro BNP improved from 1527 ± 1652 to 160 ± 3 pg/ml (p = 0.0001), 6 min walk distance (6MWD) from 359 ± 124 to 518 ± 11 m (p = 0.0001), and almost all patients returned to functional class I or II (p = 0.0001). Conclusion: Pulmonary endarterectomy for patients with CTEPH has shown a dramatic improvement of clinical status with excellent long-term survival.

Key Words: Pulmonary endarterectomy • Pulmonary hypertension • Survival • Surgical outcomes