Life expectancy after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a Swedish single-center study

Abstract

Pulmonary endarterectomy is the guideline recommended treatment for chronic thromboembolic pulmonary hypertension, in addition to life-long anticoagulation therapy. The aim was to analyze long-term relative survival after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. We included all patients who underwent pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension at Karolinska University Hospital between 1997 and 2018 (n = 100). We obtained baseline characteristics and vital status from patient charts and national health-data registers. The expected survival from the general Swedish population matched by age, sex, and year of surgery was obtained from the Human Mortality Database. The relative survival was used as an estimate of cause-specific mortality. The mean age of the patients was 62 years and 39% were women. Most patients were severely symptomatic (95% in New York Heart Association functional class III-IV), and mean preoperative systolic/diastolic (mean) pulmonary artery pressure was 78/27 (45) mmHg. The mean and maximum follow-up time was 7.2 and 22.1 years, respectively. Early (30-day) mortality was 7%. The 15-year observed, expected, and relative survival was 55% (95% confidence interval, 40%-68%), 71%, and 77% (95% confidence interval, 56%-95%), respectively. The 15-year relative survival conditional on 30-day survival was 83% (95% confidence interval, 60%-100%). Although the life expectancy following pulmonary endarterectomy was shorter compared to the general population, the difference was small in those who survived the operation and the early postoperative period. Patients with chronic thromboembolic pulmonary hypertension who are surgical candidates should undergo pulmonary endarterectomy to improve prognosis.

Keywords: chronic thromboembolic pulmonary hypertension; life expectancy; pulmonary endarterectomy; survival.

Fig. 1.

Number of patients who underwent pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension per year at Karolinska University Hospital from 1997 to 2018.

Fig. 2.

Kaplan–Meier estimated survival in patients who underwent pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension from 1997 to 2018. The upper panel shows the survival in the total study population, and the bottom panel shows the survival conditional on patient survival beyond 30 days after pulmonary endarterectomy.

Fig. 3.

The observed survival (95% confidence interval) in patients after pulmonary endarterectomy (red solid line and red dashed lines) compared to the expected survival of an age-, sex-, and calendar-year matched Swedish population (black line). The upper panel shows the survival in the total study population (n = 100), and the bottom panel shows the survival conditional on patient survival beyond 30 days after pulmonary endarterectomy (n = 93).

Fig. 4.

The relative survival (95% CI) in men and women after pulmonary endarterectomy. A relative survival of 100% signifies that patients with chronic thromboembolic pulmonary hypertension who underwent pulmonary endarterectomy have the same survival as people of the same age in the general Swedish population. As shown in the graph, the relative survival was less than 100%, particularly in women. CI: confidence interval.