Early outcomes after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in the era of epoprostenol sodium

Objectives: Pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is technically demanding. We reviewed the surgical outcomes of consecutive patients who underwent PEA with aggressive use of pulmonary vasodilators, including epoprostenol sodium. Methods: We retrospectively assessed perioperative clinical data of 122 patients with CTEPH who underwent PEA with hypothermic circulatory arrest between 2005 and 2013. Peri-operatively, all of the patients received pulmonary vasodilator therapy, including epoprostenol sodium and beraprost sodium. Results: Patients were classified as having CTEPH type 1 (n=57), type 2 (n=32), and type 3 (n=33) disease according to the Jamison classification system. In-hospital mortality was 7.4% (n=9), caused by right heart failure (n=5), pulmonary hemorrhage (n=3), and pneumonia (n=1). The 113 patients who survived PEA showed significantly decreased mPAP (46±11 to 23±10 mmHg, P<0.01) and PVR (826±357 to 237±153 dyne·s–1·cm–5, P<0.01). Conclusions: Aggressive pulmonary vasodilator treatment during surgical PEA results in favorable early outcomes. This treatment also leads to immediate and substantial improvement in pulmonary hemodynamics in patients with CTEPH.