Christoph B Wiedenroth1, Dirk Bandorski2, Kanischka Ariobi1, H-Ardeschir Ghofrani3,4,5, Mareike Lankeit6,7, Christoph Liebetrau8,9,10, Diethard Pruefer1, Eckhard Mayer1, Steffen D Kriechbaum8,9, Stefan Guth1. 1. Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 2. Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany. 3. Department of Pulmonology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 4. Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Giessen, Germany. 5. Department of Medicine, Imperial College, London, United Kingdom. 6. Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany. 7. Germany Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Germany. 8. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 9. German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Frankfurt am Main, Germany. 10. Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany.
Abstract
BACKGROUND: The gold standard treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Little is known about the influence of advanced age on surgical outcome. Therefore, the aim of this study was to investigate the impact of patient's age on postoperative morbidity, mortality, and quality of life in a German referral center. METHODS: Prospectively collected data from 386 consecutive patients undergoing PEA between 01/2014 and 12/2016 were analyzed. Patients were divided into three groups according to their age: group 1: ≤ 50 years, group 2: > 50 ≤ 70 years, group 3: > 70 years. RESULTS: After PEA, distinct improvements in pulmonary hemodynamics, physical capacity (World Health Organization [WHO] functional class and 6-minute walking distance) and quality of life were found in all groups. There were more complications in elderly patients with longer time of invasive ventilation, intensive care, and in-hospital stay. However, the in-hospital mortality was comparable (0% in group 1, 2.6% in group 2, and 2.1% in group 3 [p = 0.326]). Furthermore, the all-cause mortality at 1 year was 1.1% in group 1, 3.2% in group 2, and 6.3% in group 3 (p = 0.122). CONCLUSIONS: PEA is an effective treatment for CTEPH patients of all ages accompanied by low perioperative and 1-year mortality. CTEPH patients in advanced age carefully selected by thorough preoperative evaluation should be offered PEA in expert centers to improve quality of life, symptoms, and pulmonary hemodynamics. Thieme. All rights reserved.
BACKGROUND: The gold standard treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Little is known about the influence of advanced age on surgical outcome. Therefore, the aim of this study was to investigate the impact of patient's age on postoperative morbidity, mortality, and quality of life in a German referral center. METHODS: Prospectively collected data from 386 consecutive patients undergoing PEA between 01/2014 and 12/2016 were analyzed. Patients were divided into three groups according to their age: group 1: ≤ 50 years, group 2: > 50 ≤ 70 years, group 3: > 70 years. RESULTS: After PEA, distinct improvements in pulmonary hemodynamics, physical capacity (World Health Organization [WHO] functional class and 6-minute walking distance) and quality of life were found in all groups. There were more complications in elderly patients with longer time of invasive ventilation, intensive care, and in-hospital stay. However, the in-hospital mortality was comparable (0% in group 1, 2.6% in group 2, and 2.1% in group 3 [p = 0.326]). Furthermore, the all-cause mortality at 1 year was 1.1% in group 1, 3.2% in group 2, and 6.3% in group 3 (p = 0.122). CONCLUSIONS: PEA is an effective treatment for CTEPH patients of all ages accompanied by low perioperative and 1-year mortality. CTEPH patients in advanced age carefully selected by thorough preoperative evaluation should be offered PEA in expert centers to improve quality of life, symptoms, and pulmonary hemodynamics. Thieme. All rights reserved.