SPC365

Year After Year, Milestone After Milestone – Growing Expertise in a Single-Center Pulmonary Endarterectomy Program

Session: Sessão de Comunicações Orais 03 – Intervenções avançadas na doença vascular pulmonar e em complicações de dispositivos
Speaker: João Reis Sabido

Congress: CPC 2026
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: João Reis Sabido; Daniel Inácio Cazeiro; Tatiana Guimarães; Manuel Abecassis; Tiago Velho; Ricardo Ferreira; Nuno Lousada; David Jenkins; Ângelo Nobre; Fausto J. Pinto; Rui Plácido

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable form of pulmonary hypertension when operability is established. Following the establishment of a national pulmonary endarterectomy (PEA) program, in collaboration with an international reference center, we report the extended experience and follow-up (FUP) outcomes of the first 14 consecutive patients (pts) treated at our institution.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Single-center, prospective, observational study of all consecutive pts selected for PEA after multidisciplinary evaluation in a dedicated CTEPH program. Surgical technique was standardized &ndash; all procedures were performed by the same operative team under deep hypothermic circulatory arrest. Clinical, echocardiographic and hemodynamic (HD) data were collected at baseline and FUP. In-hospital, early and late postoperative complications and mortality were analyzed.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Results</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Fourteen pts underwent PEA (64% female; mean age 68 years). At baseline, 64% were in WHO functional class (FC) II and in 36% in class III. Preoperative characteristics included median NT-proBNP of 1320 pg/mL, mean 6MWD of 242 m, use of PH-specific therapy in 43%, and long-term oxygen in 29%. Baseline echocardiography showed mean systolic pulmonary artery pressure (sPAP) 78 mmHg, TAPSE 18 mm and TAPSE/sPAP ratio 0.26mm/mmHg. HD evaluation revealed mean mPAP 48 mmHg, PVR 9.8 WU and CI 2.32 L/min/m&sup2;.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Median cardiopulmonary bypass and cross-clamp times were 269 and 64 minutes, respectively. Median duration of mechanical ventilation was 17h; median ICU and total hospital length of stay were 4 and 8.5 days, respectively. One pt developed reperfusion injury and 2 pts had significant postoperative bleeding. No pt required ECMO or reintervention. In-hospital and 30-day mortality were 0%.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">At a median FUP of 150 days, 3 pts died of non&ndash;procedure-related causes. Among survivors, WHO FC improved in 91% of pts, with 45% reaching class I. NT-proBNP decreased significantly to a median of 378 pg/mL (p=0.011). Echocardiography showed substantial improvement in sPAP (&ndash;33mmHg, p=0.002) and TAPSE/sPAP ratio (+0.19mm/mmHg, p=0.030). Right heart catheterization (available in 3 pts) demonstrated HD cure in 2 (mPAP 14 and 18 mmHg) and mild residual PH in 1 (mPAP 36mmHg with normal cardiac output).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">The stepwise expansion of our PEA program has been associated with excellent perioperative safety and meaningful clinical and HD improvement. In this initial series of 14 procedures, standardized pt selection, a dedicated multidisciplinary pathway and sustained collaboration with an experienced center enabled high-quality outcomes in a newly established program. These results support the ongoing development and consolidation of PEA within the national CTEPH care network and highlight the feasibility of building advanced surgical expertise in a single-center setting.</span></span></span></p>