Operative and Functional Outcome After Pulmonary Endarterectomy for Advanced Thromboembolic Pulmonary Hypertension

Leung Wai Sang,
Stephane; Morin, Jean‐Francois; Hirsch, Andrew.

Journal of Cardiac
Surgery, January 2016, Vol. 31 Issue: Number 1 p3-8, 6p;


To  evaluate the midterm hemodynamic and functional outcome of pulmonary
endarterectomy (PEA) for patients with advanced chronic thromboembolic
pulmonary hypertension (CTEPH). Thirty‐eight consecutive patients
underwent PEA for CTEPH from May 2004 to March 2012. All patients were
followed prospectively at six months postoperatively and annually
thereafter. Each patient underwent serial cardiopulmonary exercise
testing (CPET) and transthoracic echocardiography, and were followed
for up to four years. Overall, 31.5% (12/38) of patients had Jamieson
class II disease while 65.8% (25/38) had class III disease. There were
three in‐hospital mortalities (7.9%), all of which had baseline
pulmonary vasculature resistance (PVR) greater than
1400 dynes‐sec‐cm−5. Preoperative PVR and mean pulmonary artery
pressure were 1209 ± 723 dynes‐sec‐cm−5and 50 ± 14 mmHg, respectively,
signifying a high‐risk operative group. Ninety‐seven percent of
patients were in NYHA class III or IV preoperatively. At median
follow‐up of 29 months 89.5% (17/19) of patients were in NYHA class I
or II. CPET revealed a progressive increase in peak oxygen consumption
from 16.5 ± 4.1 ml/kg/min at first follow‐up, to a plateau of
20.2 ± 5.6 ml/kg/min (p = 0.032) at two years. CPET can be used to
quantify progress in functional capacity post‐CTEPH, although
improvements in peak oxygen consumption plateau at two years.