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Clinical Outcomes of Endoscope-Assisted Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension

 Hyo-Hyun Kim  ;  Hyun-Soo Lee  ;  Hyun-Sik Kim  ;  Young-Nam Youn 
 YONSEI MEDICAL JOURNAL, Vol.64(2) : 104-110, 2023-02 
Journal Title
Issue Date
Chronic Disease ; Endarterectomy / adverse effects ; Humans ; Hypertension, Pulmonary* / etiology ; Hypertension, Pulmonary* / surgery ; Pulmonary Artery / surgery ; Pulmonary Embolism* / surgery ; Retrospective Studies ; Treatment Outcome
Pulmonary arterial hypertension ; endarterectomy ; functional status
Purpose: Pulmonary thromboembolism is a potentially life-threatening condition in patients with heart disease; however, limited studies discussing long-term outcomes exist. This study aimed to investigate the long-term outcomes of pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH), focusing on the improvement of functional class and right ventricular (RV) pressure.

Materials and methods: Clinical data of patients with CTEPH were obtained from Yonsei Hospital between May 2012 and December 2021, and reviewed retrospectively. Twenty-six patients underwent endoscope-guided PEA during the study period, and the mean follow-up duration was 24.8±23.4 months.

Results: After PEA, most patients (88.5%) were weaned from inotropes without extracorporeal membrane oxygenation support during the first few days. Two patients (7.6%) had cerebrovascular accidents without neurological deficits. On echocardiography, the RV systolic pressure and tricuspid regurgitation grades significantly improved (p<0.001). Furthermore, the mean left ventricle end-diastolic diameter was significant increased (p=0.003), and the left ventricular end-systolic diameter increased (p<0.001). The median intensive care unit stay was 3.0±9.4 days, and median hospital stay 16.0±26.5 days. The 5-year survival rate was 95.5%, and the 5-year freedom rate of cardiac death was 100%. There was a marked improvement in New York Heart Association (NYHA) status (p<0.001). Cox regression suggested that the main pulmonary artery (MPA) involvement is a significant predictor of non-improvement in functional class post-PEA.

Conclusion: Mortality rates are low and patients experience a marked improvement in NYHA class and health status after PEA. Moreover, MPA involvement may affect functional outcomes.
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1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyohyun(김효현) ORCID logo https://orcid.org/0000-0002-1608-9674
Youn, Young Nam(윤영남)
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