Descriptive Analysis of Oxygen Dependency and Hemodynamic Changes Following Pulmonary Thromboendarterectomy in Chronic Thromboembolic Pulmonary Hypertension Patients.

Background Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by persistent clot burden and secondary vascular remodeling. Pulmonary thromboendarterectomy (PTE) remains the preferred curative treatment for CTEPH. This study presents a descriptive analysis of surgical outcomes in patients undergoing PTE for CTEPH at a tertiary referral hospital.  Methods From 2015 to 2023, 40 CTEPH patients underwent PTE. Data on perioperative and postoperative outcomes were retrospectively collected. Continuous variables were compared between two independent groups by the Wilcoxon rank-sum test, and the Wilcoxon signed-rank test was used for comparison of pre-op and post-op variables of the same patient. Results There was an overall improvement in postoperative hemodynamics. Postoperative hemodynamics were not affected by surgical classification of disease level (59.5% of cases were Level 2 lobar lesions). After a median follow-up of three years, the overall survival rates were 0%, 10%, and 7.5%, respectively. Patients unable to discontinue oxygen at discharge had longer median circulatory arrest times (44.5 versus 23 minutes; p=0.019). Patients requiring at least 1 L/min of oxygen preoperatively had a longer hospital length of stay (LOS) than patients without oxygen requirements (25 versus 10 days; p=0.019). Lower tricuspid annular plane systolic excursion (TAPSE) (p=0.0013), higher right atrial pressure (p=0.0013), and higher mean pulmonary artery pressure (mPAP) (p=0.048) preoperative values were also associated with increased LOS. Conclusions PTE improves hemodynamic parameters in patients with CTEPH, with an acceptable safety profile. Clinicians must identify risk factors accurately in order to weigh the benefits and risks of surgery and help intensivists identify high-risk patients. There are certain risk factors that may require closer hemodynamic monitoring, which could improve prognosis by personalizing management strategies. Future research should focus on optimizing patient selection criteria through predictive modeling, refining surgical techniques to reduce circulatory arrest times, and exploring the long-term benefits of adjunctive therapies. The hypothesis that patients without the need for supplemental oxygen have shorter hospital stays after PTE is supported by the physiological basis that these patients are less likely to experience severe reperfusion injury, have less significant microvasculopathy, and exhibit better hemodynamic stability. In contrast, patients requiring oxygen may face more complex postoperative challenges, necessitating longer hospital stays for adequate management and recovery.