Impact of residual pulmonary hypertension on long‐term outcomes after pulmonary endarterectomy in the modern era

Abstract Residual pulmonary hypertension (PH) negatively impacts long‐term results following pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH). We sought to reveal whether modern PH therapy with PH‐targeted medicine and balloon pulmonary angioplasty (BPA) improved long‐term results of residual PH after PEA. Long‐term findings of 80 patients who survived PEA between 2011 and 2019 were retrospectively investigated. One month after PEA, 30 patients developed residual PH defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg, of whom 23 were treated by PH‐targeted medicine and 9 by BPA. Patients with residual PH acquired considerably better functional status and exercise capacity after PEA, however, exhibited significantly worse survival rates than those without. Eleven patients died during follow‐up: 8 patients with residual PH and 3 controls. Among patients with residual PH, the deceased had a significantly lower %decrease in mPAP from 1 month to 1 year following PEA (7.4 [−32.6 to 8.0] % vs. 10.4 [3.7−27.8] %, p = 0.03) and higher mPAP at 1 year following PEA (39.5 [33.25−42.5] vs. 27 [26−34] mmHg, p