Thorac Cardiovasc Surg
DOI: 10.1055/s-0041-1740559
Original Thoracic

Does Age Matter? Pulmonary Endarterectomy in the Elderly Patient with CTEPH

Christoph B. Wiedenroth
1   Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
,
Dirk Bandorski
2   Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
,
Kanischka Ariobi
1   Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
,
H.-Ardeschir Ghofrani
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
,
Mareike Lankeit
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
,
Christoph Liebetrau
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
,
Diethard Pruefer
1   Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
,
Eckhard Mayer
1   Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
,
Steffen D. Kriechbaum*
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
,
Stefan Guth*
1   Department of Thoracic Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
› Author Affiliations
Funding Funded by the Deutsche Forschungsgemeinschaft (DFG), CRC1213, project CP01.

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.

Declarations


Ethics Approval and Consent to Participate

All patients were informed in detail and gave written informed consent to participate. The local ethics committee approved this prospective observational study (AZ 218/13, Giessen University Ethics Committee) and is in accordance with the declaration of Helsinki.


Consent for Publication

All patients furthermore agreed with publication of scientific results of the obtained data.


Availability of Data and Material

All data has been stored pseudonymized in a password-secured database.


Authors' Contributions

CBW, DB, HAG, EM, and SG conceptualized and designed the work.


CBW, DB, KA, CL, SDK, and SG acquired and analyzed the data.


CBW, DB, HAG, SDK, CL, DP, SDK, and SG interpreted the data.


CBW, DB, ML, CL, SDK, and SG drafted the work and substantively revised it.


CBW, DB, KA, HAG, ML, CL, DP, EM, SDK, and SG approved the submitted version.


CBW, DB, KA, HAG, ML, CL, DP, EM, SDK, and SG agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.


* Both authors contributed equally as last authors.




Publication History

Received: 14 July 2021

Accepted: 15 October 2021

Publication Date:
17 January 2022 (online)

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