Safety and Immediate Efficacy of Pulmonary Thromboendarterectomy for Chronic Thromboembolic Disease.

Abstract

Chronic thromboembolic disease (CTED) is characterized by pulmonary vascular thromboembolic occlusions without elevation in pulmonary artery pressures or pulmonary vascular resistance at rest. Many patients have dyspnea on exertion despite normal resting hemodynamics and symptomatic improvement after pulmonary thromboendarterectomy surgery. We hypothesize that the safety and efficacy of pulmonary thromboendarterectomy in CTED will be similar to that in chronic thromboembolic pulmonary hypertension (CTEPH), which currently has a better characterized risk-benefit profile. Patients who underwent pulmonary thromboendarterectomy for CTED from 2009 through 2022 had preoperative and postoperative pulmonary hemodynamics and postoperative course (n = 163) compared with a reference CTEPH cohort who underwent pulmonary thromboendarterectomy from 2017 to 2022 (n = 870). Preoperative rest hemodynamics were compared with both preoperative exercise and postoperative rest hemodynamics in patients with CTED who had measurements for all 3 conditions. The CTED cohort had 99 patients with complete preoperative rest, preoperative exercise, and postoperative hemodynamic measurements. Mean pulmonary artery pressure, pulmonary vascular resistance, and pulmonary artery compliance all changed abnormally with preoperative exercise but improved after surgery (21 [SD, 4], 36 [SD, 10], 18 [interquartile range {IQR}15-21] mm Hg; 175 [SD, 87], 205 [SD, 149], 126 [SD, 55] dyne·s·cm^-5; 3.6 [IQR, 3.1-4.4], 2.7 [IQR, 2.1-3.6], 4.8 [IQR, 3.7-6.0] mL/mm Hg; preoperative rest, exercise, and postoperative for mean pulmonary artery pressure, pulmonary vascular resistance, and compliance; P < .001 for all comparisons, mean [SD] if normally distributed, otherwise median [IQR]). CTED patients had no in-hospital mortality and shorter hospital and intensive care unit lengths of stay (P < .001 for both) compared with the CTEPH cohort. Pulmonary thromboendarterectomy is safe and well-tolerated in patients with CTED, improving pulmonary hemodynamics and pulmonary artery compliance.