Clinical and hemodynamic outcomes and mortality risk factors in patients undergoing pulmonary thromboendarterectomy




Cristhian F. Ramirez-Ramos, Department of Interventional Cardiology and Hemodynamics and Department of Cardiology and Heart Failure, Universidad Pontificia Bolivariana, Clínica cardioVID; Medellín, Colombia
Clara Saldarriaga-Giraldo, Department of Cardiology and Heart Failure, Universidad Pontificia Bolivariana, Clínica cardioVID; Universidad de Antioquia, Medellín; Medellín, Colombia
Manuela Yepes-Calderon, Universidad de Antioquia, Medellín, Colombia
Gustavo Castilla-Agudelo, Department of Cardiology and Heart Failure, Universidad Pontificia Bolivariana, Clínica cardioVID;, Medellín, Colombia
Mateo Aranzazu-Uribe, Department of Internal Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
Santiago Saldarriaga-Betancur, Department of Internal Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
Paulina Castro, Department of Anesthesiology, Universidad Pontificia Bolivariana, Medellín, Colombia
Alejandro Londoño, Department of Pulmonology and Pulmonary Hypertension Clinic, Clínica cardioVID, Medellín, Colombia
Hector Ortega, Department of Pulmonology and Pulmonary Hypertension Clinic, Clínica cardioVID, Medellín, Colombia
Jorge Zapata- Sanchez, Cardiovascular Surgery Department, Universidad Pontificia Bolivariana, Clínica cardioVID, Medellín, Colombia
Eliana Cañas, Epidemiology Department, Universidad Pontificia Bolivariana, Clínica cardioVID. Medellín, Colombia
Juan C. Rendon-Isaza, Cardiovascular Surgery Department, Universidad Pontificia Bolivariana, Clínica cardioVID, Medellín, Colombia


Background: Pulmonary thromboendarterectomy is the current treatment of choice in patients with chronic thromboembolic pulmonary hypertension. The objective of the present study was to analyze the clinical and hemodynamic outcomes and the risk factors for mortality in a cardiovascular center in Colombia. Methods: Cohort study, conducted between 2001 and 2019. All operated patients were included in the study. Risk factors associated with mortality were established by means of a multivariate regression using the COX method and survival was established using the Kaplan–Meier method. p < 0.05 was considered statistically significant. Results: Seventy-three patients were operated. Median age was 51 years, 55% of females, 79% had functional Class III and IV. The mean pulmonary arterial pressure was 50 mmHg and 640 dyn.s.cm−5 for pulmonary vascular resistance (PVR). After the intervention, there was a decrease in mean pulmonary artery pressure (p ≤ 0.001) and in PVR (p = 0.357); 21% had evidence of residual pulmonary hypertension. Only 8% and 6% continued with functional Class III and IV at 6 and 12 months, respectively. There were 15 deaths (19.1%; 12% at 30 days). The factors associated with mortality were the diastolic diameter of the right ventricle measured postoperatively (hazard ratio [HR] 10.88 95% confidence interval [CI] 1.97-62, p = 0.007), time of invasive mechanical ventilation (HR 1.06 95% CI 1.02-1.09 p = 0.004), and the presence of complications during the surgical procedure (HR 5.62 95% CI 1.94-16.22 p = 0.001). Conclusions: Pulmonary thromboendarterectomy is associated with excellent clinical and hemodynamic outcomes. The mortality risk factors found are not those usually described in the literature.



Palabras clave: Pulmonary hypertension. Pulmonary embolism. Pulmonary thromboendarterectomy.