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OBJECTIVE: Pulmonary endarterectomy is the operation of choice for thromboembolic pulmonary hypertension. As the largest referral center for thromboembolic pulmonary hypertension in the world, we are frequently asked whether patients with extreme pulmonary hypertension [pulmonary artery systolic pressures (PAS) exceeding 100mmHg] can safely undergo this operation with therapeutic benefit.
METHODS: To determine if patients with PAS>100 mmHg have favorable outcome after pulmonary endarterectomy, we reviewed the outcomes of 743 patients who underwent this operation between 1999-2004. We compared hemodynamic and outcome parameters of 65 patients (Group 1: 26 male, 39 female, mean age 49.5) who had preoperative PAS>100mmHg to 678 patients (Group 2: 314 male, 364 female, mean age 50.3) with preoperative PAS<100mmHg.
RESULTS: Group1 patients had a greater overall dimunition in pulmonary vascular resistance (mean decrease: 926.7±511.1 vs. 546.4±365.1dynes/sec/cm^-5, p<0.01) and reduction in PAS (mean decrease: 50.5±18.7 vs. 27.2±18.6mmHg, p<0.05), with similar improvement in cardiac output (mean increase: 1.53±1.47, vs. 1.55±1.58L/min) compared to Group2 patients. Although length of hospital stays, and discharge pO₂ were similar for the two groups, overall perioperative survival was slightly lower in Group1 patients (89.2%; 58/65 for Group1 vs. 96.5%; 654/678 for Group2). Patients with extreme pulmonary hypertension manifest a higher rate of postoperative reperfusion edema, leading to longer days of intubation compared to Group2 patients.
CONCLUSIONS: Pulmonary endarterectomy may be performed safely in patients with severe thromboembolic pulmonary hypertension. The magnitude of preoperative PAS or PVR is not a contraindication for surgery. Indeed, patients with extreme pulmonary hypertension may benefit most from this operation.