Long-term outcome after pulmonary endarterectomy

Rationale: There are few follow-up studies on long-term cardiopulmonary function after pulmonary endarterectomy (PEA), the operation of choice for chronic thromboembolic pulmonary hypertension (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) weretreated withPEAat Pavia University Hospital.Thepatientswere 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 monoxide transfer factor (TLCO), arterial blood gas, and treadmill incremental exercise test. Measurements and Main Results: Cumulative survival was 84%. Within 3 months, 18 patients died in-hospital and 2 had lung transplantation; 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 improvement 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.