Risk stratification in patients with residual pulmonary hypertension after pulmonary endarterectomy.

Abstract Background Few studies addressed the issue of risk stratification in patients with residual pulmonary hypertension (pH) after pulmonary endarterectomy (PEA). This study tested the potential added value of parameters that have not been included in existing risk models. Methods We evaluated 546 consecutive patients with chronic thromboembolic pulmonary hypertension who underwent PEA and were followed-up for a median period of 58 months. Results Among the 242 with residual PH, 27 died and had 127 a clinical worsening event. At univariable analysis, the parameters associated with poor survival were pulmonary vascular resistance (PVR) ≥425 dyn·s·cm−5 (p ≤0.001), mean pulmonary artery pressure (mPAP) ≥38 mmHg (p = 0.003) and pulmonary artery compliance (CPA) ≤1.8 ml/mmHg (p = 0.014). In the bivariable models including either PVR or mPAP as first parameter, the addition of CPA was not statistically significant. The parameters associated with poor clinical worsening were CPA ≤1.8 ml/mmHg (p  Conclusions Risk stratification in residual PH can be refined if CPA and PaO2 are considered in association with standard hemodynamic parameters.