Preoperative Right Ventricle-to-Pulmonary Artery Coupling Correlates With Intensive Care Length of Stay After Pulmonary Endarterectomy.

OBJECTIVES

To investigate whether preoperative noninvasive measurement of right ventricle-to-pulmonary artery coupling, assessed by the tricuspid annular plane systolic excursion-to-pulmonary artery systolic pressure (TAPSE:PASP) ratio, is associated with perioperative outcomes following pulmonary endarterectomy (PEA).

DESIGN

Retrospective, single-center cohort study.

SETTINGS: Tertiary university hospital: national center for chronic thromboembolic pulmonary hypertension (CTEPH) treatment.

PARTICIPANTS

Patients with CTEPH eligible for PEA.

INTERVENTIONS: Patients underwent transthoracic echocardiography and right heart catheterization before undergoing PEA. The TAPSE:PASP ratio was calculated from preoperative echocardiography and dichotomized at 0.17 mm/mmHg.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was intensive care unit (ICU) length of stay (LOS). Secondary outcomes included vasoactive and inotropic therapy, representing perioperative hemodynamic instability. Sixty patients were included. The median TAPSE:PASP ratio was 0.20 mm/mmHg (interquartile range [IQR], 0.15-0.29 mm/mmHg); 38% of patients had ratios below 0.17 mm/mmHg. A lower TAPSE:PASP ratio was associated with higher N-terminal pro-brain natriuretic peptide levels and pulmonary vascular resistance, as well as greater right ventricular dilatation. The median ICU LOS was longer in patients with a TAPSE:PASP ratio below 0.17 mm/mmHg (96 hours [IQR, 60-218 hours] v 63 hours [IQR, 41-93 hours], p = 0.0044), with an odds ratio (OR) of 3.45 (95% confidence interval [CI], 1.16-11.11) for ICU LOS greater than 72 hours. Patients with lower TAPSE:PASP ratios had a higher (OR, 3.33; 95% CI, 1.11-10.00; p = 0.032) and prolonged (OR, 3.70; 95% CI, 1.23-11.11; p = 0.019) need for vasoactive and inotropic therapy.

CONCLUSIONS

A lower preoperative TAPSE:PASP ratio was associated with prolonged ICU stay and hemodynamic compromise after PEA. The TAPSE:PASP ratio may serve as a valuable, noninvasive tool for preoperative risk stratification in patients with CTEPH undergoing surgical treatment.