Does Age Matter? Pulmonary Endarterectomy in the Elderly Patient with CTEPH

Abstract

Background The gold standard treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Little is known about the influence of advanced age on surgical outcome. Therefore, the aim of this study was to investigate the impact of patient's age on postoperative morbidity, mortality, and quality of life in a German referral center.

Methods Prospectively collected data from 386 consecutive patients undergoing PEA between 01/2014 and 12/2016 were analyzed. Patients were divided into three groups according to their age: group 1: ≤ 50 years, group 2: > 50 ≤ 70 years, group 3: > 70 years.

Results After PEA, distinct improvements in pulmonary hemodynamics, physical capacity (World Health Organization [WHO] functional class and 6-minute walking distance) and quality of life were found in all groups. There were more complications in elderly patients with longer time of invasive ventilation, intensive care, and in-hospital stay. However, the in-hospital mortality was comparable (0% in group 1, 2.6% in group 2, and 2.1% in group 3 [p = 0.326]). Furthermore, the all-cause mortality at 1 year was 1.1% in group 1, 3.2% in group 2, and 6.3% in group 3 (p = 0.122).

Conclusions PEA is an effective treatment for CTEPH patients of all ages accompanied by low perioperative and 1-year mortality. CTEPH patients in advanced age carefully selected by thorough preoperative evaluation should be offered PEA in expert centers to improve quality of life, symptoms, and pulmonary hemodynamics.

Keywords

pulmonary vascular resistance/hypertension - pulmonary embolism - surgery - complications - outcomes (includes mortality morbidity)

Ethics Approval and Consent to Participate

All patients were informed in detail and gave written informed consent to participate. The local ethics committee approved this prospective observational study (AZ 218/13, Giessen University Ethics Committee) and is in accordance with the declaration of Helsinki.

Consent for Publication

All patients furthermore agreed with publication of scientific results of the obtained data.

Availability of Data and Material

All data has been stored pseudonymized in a password-secured database.

Authors' Contributions

CBW, DB, HAG, EM, and SG conceptualized and designed the work.

CBW, DB, KA, CL, SDK, and SG acquired and analyzed the data.

CBW, DB, HAG, SDK, CL, DP, SDK, and SG interpreted the data.

CBW, DB, ML, CL, SDK, and SG drafted the work and substantively revised it.

CBW, DB, KA, HAG, ML, CL, DP, EM, SDK, and SG approved the submitted version.

CBW, DB, KA, HAG, ML, CL, DP, EM, SDK, and SG agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

^* Both authors contributed equally as last authors.

Publikationsverlauf

Eingereicht: 14. Juli 2021

Angenommen: 15. Oktober 2021

Artikel online veröffentlicht:
17. Januar 2022

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