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EP30 PULMONARY ENDARTERECTOMY: PROXIMAL VERSUS DISTAL LESIONS IN HIGH PULMONARY VASCULAR RESISTANCE COHORT

Background: Pulmonary endarterectomy(PEA) is the treatment of choice in chronic thromboembolic pulmonary hypertension(CTEPH). High preoperative pulmonary vascular resistance (PVR) is the main negative prognostic factor. Location of obstructive lesions (proximal versus distal) only determines surgical accessibility.The aim of this study is to determine the impact of high PVR associated with distal disease. Methods: We retrospectively analyze the results of 149 PEA performed since 2003. Of this cohort 37.6% of patients had PVR≥800 dynes; of them, 5 had a distal angiographic profile (distal segmental and subsegmental involvement). We compare outcomes of proximal versus distal lesion. Results: In-hospital mortality of high PVR cohort was 19.6% (versus 6.4% of lower PVR p = 0.026; OR = 3.3;CI[1.2;9.6]). Patients with proximal anatomy died less than those with distal anatomy (8/51 versus 3/5). Distal lesions were risk factor for early (p = 0.04, OR = 11.4;CI[1.1;52.4]) but not for late mortality (p = 0.81); those patients also developed acute renal failure (p = 0.04;OR = 7.5;CI[1.1;121.7]) and need for extracorporeal membrane oxigenation (4/5 patients; p = 0.02;OR = 17.3;CI[1.7;174.3]). At 3 years and 10 years follow up, overall survival was 94.8% and 88.6% respectively (mean follow up time 71.7 ± 43.6 months). Freedom from persistent pulmonary hypertension is 88.9% at 10 years follow up. Conclusions: Our results demonstrate that patients with high PVR associated with distal lesions have even worse early outcomes than those with high PVR alone. Further studies regarding this finding are necessary to define if this population might benefit from other therapies like pulmonary angioplasty and/or medical treatment rather than PEA.