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. 2025 Mar 14;25(1):119.
doi: 10.1186/s12890-025-03575-3.

Overlap and correlation of reperfusion lung injury with postoperative pneumonia following pulmonary thromboendarterectomy: incidence, characteristics, and outcomes in chronic thromboembolic pulmonary hypertension

Shardul N Rathod  1 , Pamela Ropski  2 , Jakub Glowala  2 , Charles M Quinn  3 , Alyssa Stamper  3 , Maureen K Bolon  4 , Daniel Schimmel  5 , Stephen F Chiu  6 , S Chris C Malaisrie  6 , Mike J Cuttica  3 , Ruben Mylvaganam  7   8
Affiliations

Overlap and correlation of reperfusion lung injury with postoperative pneumonia following pulmonary thromboendarterectomy: incidence, characteristics, and outcomes in chronic thromboembolic pulmonary hypertension

Shardul N Rathod et al. BMC Pulm Med. .

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) can be treated with pulmonary thromboendarterectomy (PTE) which may lead to reperfusion lung injury (RPLI) and postoperative pneumonia. We aimed to describe the incidence, diagnostic characteristics, and clinical outcomes of post-PTE pneumonia compared to RPLI. A retrospective study involving CTEPH subjects who underwent PTE at a large referral center was conducted. Data included demographics, hemodynamics, microbiologic diagnostics, and clinical outcomes. Post-PTE pneumonia was diagnosed based on documentation, signs/symptoms, or microbiologic sampling within seven days of surgery. Among 75 PTE subjects, 21 (28%) had RPLI, and 18 (24%) had post-PTE pneumonia. Of those with RPLI, 48% had pneumonia, suggesting overlap. Eight of 75 (11%) subjects underwent bronchoscopic sampling, and five (63%) samples yielded positive results indicative of infection. Subjects with post-PTE pneumonia and RPLI had longer hospital and ICU lengths of stay and mechanical ventilation duration than either group alone. Post-PTE pneumonia is prevalent and overlaps with RPLI in CTEPH subjects. The study highlights the importance of systematic evaluation and early detection of pneumonia in subjects with RPLI post-PTE. Timely diagnosis and management of pneumonia may improve outcomes. Further research is needed to understand risk factors and develop preventive strategies for post-PTE pneumonia.

Keywords: Chronic thromboembolic pulmonary hypertension (CTEPH); Outcome assessment; Postoperative pneumonia; Pulmonary thromboendarterectomy (PTE); Reperfusion lung injury (RPLI).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study received approval from the Northwestern University Institutional Review Board (IRB) STU00009959. All patients provided informed written consent for the presentation and publication of their study data, adhering to ethical standards in accordance with the Declaration of Helsinki. Clinical trial number: As this study involved standard clinical procedures and assessments without an experimental treatment protocol, it did not require registration with a public clinical trials registry. Competing interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ruben Mylvaganam reports a relationship with United Therapeutics Corporation Research and Development that includes: consulting or advisory. Michael Cuttica reports a relationship with United Therapeutics Corporation Research and Development that includes: consulting or advisory. Michael Cuttica reports a relationship with Janssen Pharmaceuticals Inc that includes: consulting or advisory. Michael Cuttica reports a relationship with Bayer Corporation that includes: consulting or advisory. Michael Cuttica reports a relationship with Insemd that includes: funding grants. Ruben Mylvaganam reports a relationship with Janssen Pharmaceuticals Inc that includes: funding grants. Daniel Schimmel reports a relationship with Penumbra Inc that includes: consulting or advisory, funding grants, and speaking and lecture fees. Daniel Schimmel reports a relationship with Inari Medical Inc that includes: consulting or advisory, funding grants, and speaking and lecture fees. Daniel Schimmel reports a relationship with Sanofi-Aventis US LLC that includes: funding grants. Daniel Schimmel reports a relationship with Boston Scientific Corp that includes: consulting or advisory and funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors received no funding for this study. The authors declare that they have no financial interests or relationships that could be perceived as a conflict of interest regarding the publication of this manuscript.

Figures

Fig. 1
Fig. 1
Characteristics of total cohort (n = 75) including a breakdown of subjects with and without RPLI, subjects with and without PNA, and subjects with microbiologically confirmed PNA.* 4 subjects with microbiologically confirmed PNA from the RPLI (+) group and 1 subject with microbiologically confirmed PNA from the RPLI (-) group
Fig. 2
Fig. 2
Subject outcomes related to ICU LOS, hospital LOS, and MV duration
See this image and copyright information in PMC

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