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CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2025; 73(03): 230-236
DOI: 10.1055/a-2409-5944
Original Thoracic

Pulmonary Endarterectomy: Risk Factors for Early and Late Mortality

Sehnaz Olgun Yildizeli
1   Department of Pulmonology and Intensive Care, Marmara University School of Medicine, Istanbul, Turkey
,
Hüseyin Arıkan
1   Department of Pulmonology and Intensive Care, Marmara University School of Medicine, Istanbul, Turkey
,
Sinem Güngör
2   Department of Pulmonology, Sureyyapasa Gogus Hastaliklari ve Gogus Cerrahisi Egitim ve Arastirma Hastanesi, Istanbul, Turkey
,
Aslı Tufan
3   Division of Geriatrics, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
,
Derya Kocakaya
1   Department of Pulmonology and Intensive Care, Marmara University School of Medicine, Istanbul, Turkey
,
Halil Ataş
4   Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
,
Bülent Mutlu
4   Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
,
Serpil Tas
5   Department of Cardiovascular Surgery, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
,
Koray Ak
6   Department of Cardiovascular Surgery, Marmara University School of Medicine, Istanbul, Turkey
,
G. Nural Bekiroğlu
7   Department of Biostatistics, Marmara University School of Medicine, Istanbul, Turkey
,
Bedrettin Yildizeli 
8   Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Abstract

Background Pulmonary endarterectomy (PEA) is a potentially curative treatment option for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to identify predictors of short- and long-term outcomes after PEA for CTEPH patients, including age.

Methods Patients who underwent surgery between March 2014 and January 2024 were included in the study. Perioperative and follow-up data were retrospectively studied, including age, in-hospital mortality, 1- and 5-year survival, and the length of intensive care unit (ICU) and hospital stays after PEA.

Results In total, 834 consecutive patients (mean age 51 ± 15.3 years) underwent PEA and were included in the analysis. The in-hospital mortality rate was 7.8% (n = 65), while overall mortality rates at 1 and 5 years were 10.6% and 11.3%, respectively. The in-hospital mortality rate was 6.7% for patients <70 years compared with 12.4% for patients ≥70 years (p = 0.029). In the multivariate analysis of mortality, age (p = 0.007), and length of ICU stay (p = 0.028) emerged as independent predictors of in-hospital mortality, while the Charlson Comorbidity Index (p < 0.001) and 6-minute walk distance (p = 0.005) were also significant predictors of 1-year survival.

Conclusion Despite higher short-term mortality rates, PEA was feasible and well-tolerated among elderly patients. Despite surgical advancements, careful patient selection remains crucial, particularly in the presence of comorbidities. Significant clinical and hemodynamic improvements were observed, along with favorable long-term survival outcomes.

Keywords

geriatrics - pulmonary embolism - pulmonary vascular resistance/hypertension

Authors' Contribution

Ş.O.Y.: Conceptualization, methodology, writing—original draft preparation, investigation, supervision. H.A.: Methodology, software, data curation, investigation, editing. S.G.: Methodology, data curation, investigation. A.T-Ç.: Conceptualization, methodology.D.K.: Conceptualization, methodology, data curation, investigation. H.A.: Conceptualization, data curation, methodology. B.M.: Conceptualization, data curation, methodology, supervision. S.T.: Conceptualization, data curation, methodology. K.A.: Conceptualization, data curation, methodology. G.N.B.: Data curation, methodology, investigation. B.Y.: Conceptualization, methodology, data curation, writing—original draft preparation, supervision.




Publication History

Received: 16 April 2024

Accepted: 02 September 2024

Accepted Manuscript online:
04 September 2024

Article published online:
01 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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