Outcomes of pulmonary thromboendarterectomy combined with concomitant cardiac procedures

Objective. To evaluate clinical and hemodynamic outcomes of pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing additional cardiac procedures. Material and methods. Fifty-eight patients underwent surgery between 2010 and 2022. They were divided into two groups: group 1 — isolated PEA (n=28); group 2 — PEA with concomitant cardiac procedures (n=30). Central hemodynamics, echocardiography parameters and clinical status (NYHA class, 6-minute walk test) were assessed preoperatively, postoperatively, and at follow-up (median duration 23.5 months). Results. Both groups demonstrated significant improvements in hemodynamic and clinical parameters. The combined group showed higher rates of complications, longer ICU stay and inotropic support, as well as higher in-hospital mortality (16.7% vs. 3.6%). Long-term survival was significantly lower in the combined group (73.3% vs. 96.4%, p=0.023). Multivariate regression identified preoperative right ventricular echocardiographic parameters as independent predictors of mortality. Importantly, comorbidities such as atrial fibrillation, coronary artery disease, diabetes mellitus and COPD had no significant effect on survival. Conclusion. Despite increased perioperative risks, combined PEA provides substantial clinical benefits. Patients with right ventricular dysfunction require thorough preoperative assessment and prolonged postoperative monitoring.