Safety and efficacy of a dedicated pulmonary thromboendarterectomy fellowship: The Royal Papworth experience at a high-volume center.

Abstract

Chronic thromboembolic pulmonary hypertension is a late complication of acute pulmonary embolism. Though potentially curative, pulmonary thromboendarterectomy (PTE) is technically demanding, with outcomes closely linked to institutional volume and surgeon experience. This study assessed the safety and effectiveness of training in a dedicated fellowship by comparing outcomes of PTEs performed by fellows with those performed by experienced consultant surgeons in a high-volume center. Data for all first-time PTEs performed between January 2016 and December 2025 were retrieved. Patients with incomplete data, age younger than 18 years, overseas residency, and those who did not consent to data use were excluded. Cases (through May 2025) where fellows performed bilateral endarterectomy (Group F) were identified and propensity-score matched (1 to 2 ratio) with consultant-led cases (Group C) for an outcome analysis. A total of 1744 PTEs were performed during the study period (median age, 60 years; 55.9% men, in-hospital mortality, 1.9%). Five fellows (52 fellow-months) scrubbed for 629 cases, with 312 cases as first operator (49.6% of scrubbed cases). The propensity-matched outcome analysis study cohort comprised 678 patients. Preoperative characteristics were comparable between groups. Circulatory arrest was longer in Group F (40 vs 35 minutes; P < .001). Groups had similar perioperative complication rates, including reperfusion lung injury, endobronchial bleeding, and extracorporeal membrane oxygenation utilization, with comparable hospital mortality rates. Postdischarge hemodynamic, functional, and quality-of-life outcomes, as well as long-term survival, were similar between groups. Dedicated PTE training in a high-volume center is safe and does not compromise short- or long-term outcomes. This represents the largest reported experience of training in PTE surgery.