Background: Long term changes in pulmonary hemodynamics, RV function and exercise capacity after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) are poorly described.
Methods: We analysed the data from two prospective CTEPH cohorts in Hammersmith Hospital, London and Amsterdam UMC. Available measurements consisted of right heart catheterisation, CMR imaging and cardiopulmonary exercise testing before and after PEA. With logistic regression analysis preoperative predictors of residual PH and long-term exercise intolerance (VO₂ max <80% at 18 months) were analysed.
Results: A total of 118 patients (57 Dutch and 61 UK patients) were included. Both cohorts displayed a significant improvement of pulmonary hemodynamics, RV function and exercise capacity 6 months after PEA. Between 6 and 18 months after PEA, further improvements were observed in peak work load, peak oxygen pulse and the ratio of minute ventilation to carbon dioxide production slope (all p<0.05). Residual PH was present in 34 (29%) patients. Age, female gender, systemic hypertension, PVR and DLCO were predictors of residual PH post-PEA. In addition, long-term exercise intolerance was common (59%) and associated with baseline DLCO and SvO₂.
Conclusions: Restoration in cardiopulmonary hemodynamics and exercise capacity occurs within 6 months. Substantial changes in cardiopulmonary hemodynamics do not occur between 6 and 18 months after PEA. Despite restoration of cardiopulmonary hemodynamics after surgery, long-term exercise intolerance is common and associated with baseline DLCO and SvO₂.